Remote access for ambulatory medical device

ABSTRACT

An ambulatory medical device includes a sensor configured to acquire a signal indicative of a physiological condition of a patient, a controller operatively coupled to the sensor and configured to monitor the physiological signal, and to perform a diagnostic test, and a remote access manager operatively coupled to the controller and configured to monitor for a command from a remote system to perform the diagnostic test, and to cause the controller to perform the diagnostic test in response to the command. In the device, the remote access manager may be further configured to transmit data representing an operational status of the ambulatory medical device to the remote system. The operational status of the controller may result from performing the diagnostic test. The remote access manager may be further configured to send the data representing the operational status of the ambulatory medical device in real time or substantially in real time.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/475,282, entitled “REMOTE ACCESS FOR AMBULATORY MEDICAL DEVICE,”filed Mar. 31, 2017, which claims benefit under 35 U.S.C. § 119 (e) ofU.S. Provisional Application Ser. No. 62/315,789, entitled “REMOTEACCESS FOR AMBULATORY MEDICAL DEVICE,” filed Mar. 31, 2016, each ofwhich is incorporated herein by reference in its entirety. The subjectmatter of each of the following applications is also incorporated hereinby reference in its entirety: U.S. Provisional Patent Application Ser.No. 62/235,883, entitled “Training Modules for External Medical Device,”filed Oct. 1, 2015; U.S. application Ser. No. 15/397,102, entitled“PATIENT ASSURANCE SYSTEM AND METHOD,” filed Jan. 3, 2017; U.S.application Ser. No. 15/073,923, entitled “Systems and Methods forTesting a Medical Device,” filed Mar. 18, 2016 (now published as U.S.2016/0274162); and U.S. application Ser. No. 15/233,245, entitled“SECURE LIMITED COMPONENTS FOR USE WITH MEDICAL DEVICES,” filed Aug. 10,2016 (now published as U.S. 2017/0065823).

BACKGROUND

This disclosure relates generally to external medical devices, and morespecifically, to techniques for remotely controlling and determining astatus of an ambulatory medical device.

There are a wide variety of electronic and mechanical medical devicesfor monitoring and treating medical conditions, such as cardiacarrhythmias. For instance, such medical devices may continuously orsubstantially continuously monitor the patient for a treatable medicalevent via one or more sensing electrodes. When a treatable event isdetected, such as a treatable cardiac arrhythmia, these medical devicesmay apply corrective electrical pulses or other therapeutic treatmentsdirectly to the patient through one or more therapy electrodes, orotherwise perform one or more actions triggered by the detection of theevent, such as generating an alarm.

Medical devices may experience technical problems in use that impaircertain functions, including functions for detecting or treatingcritical medical conditions. Further, medical devices may need to beupdated with new information in the field. In some cases, the patient ora technical professional may need to examine the device to identify orresolve the problem. Such examination or updates may be more difficultto perform if the device malfunctions while a patient is at his or herhome or place of work and lacks the tools or skills to effectivelytroubleshoot the problem without assistance.

SUMMARY

Ambulatory medical devices can play an important role in many treatmentregimens. Given the nature of such devices, certain aspects of thetreatment regimens may occur outside of the immediate supervision ofmedical and technical professionals. For example, ambulatory medicaldevices do not fully constrain movement of the patient, thus permittingthe patient to carry out a normal lifestyle while the device is in use.Often these medical devices are complex instruments, having varioussubsystems, components, and configuration options. As such, manypatients have little knowledge or understanding of the proper operationof the devices. Therefore, patients may rely on the devices toautomatically notify them when a problem is detected. However, there maybe cases where the patient is unable to troubleshoot the problem on hisor her own, and thus requires assistance from a technical expert. If thepatient is using the device at home or in another setting where thetechnical expert is not located, then the technical expert may wish todirectly interact with the device or observe the operation of the devicefrom a remote location.

To this end, techniques are disclosed for remotely controlling anddetermining a status of an ambulatory medical device. In one example, anambulatory medical device includes a sensor configured to monitor asignal indicative of a physiological condition of a patient over anextended period of time; a controller operatively coupled to the sensorand configured to monitor the physiological signal over the extendedperiod of time; a remote access manager operatively coupled to thecontroller and configured to monitor for a command from one of a remotesystem or remote computing device to perform a diagnostic test; to causethe controller to perform the diagnostic test in response to the commandwherein the diagnostic test comprises identifying whether an operationalstatus of the ambulatory medical device is in a critical operationalstatus or non-critical operational status; a user interface operativelycoupled to the controller and configured to display an instruction tothe patient indicative of the operational status of the ambulatorymedical device wherein the instruction comprises at least one ofdiscontinuing use of the device and contacting a remote technician wherethe operational status is critical operational status, and continuinguse of the device and contacting a remote technician where theoperational status is non-critical operational status; and a datacommunications interface configured to transmit data representing theoperational status to a remote system.

In one example, an ambulatory medical device includes a sensorconfigured to monitor a signal indicative of a physiological conditionof a patient over an extended period of time; a controller operativelycoupled to the sensor and configured to monitor the physiological signalover the extended period of time; a remote access manager operativelycoupled to the controller and configured to monitor for a command tocommunicate with a remote system, and to establish a communicationsession with the remote system in response to the command forcommunication between the ambulatory medical device and the remotesystem in real time or substantially in real time.

In one example, an ambulatory medical device includes a sensorconfigured to acquire a signal indicative of a physiological conditionof a patient; a data communications interface; and a controlleroperatively coupled to the sensor and to the data communicationsinterface, the controller configured to monitor the physiologicalsignal, to receive a command to establish a communication session with aremote system via the data communications interface, to establish thecommunication session in response to receiving the command, and totransmit data representing an operational status of the ambulatorymedical device to the remote system via the communication session inresponse to receiving the command.

In one example, an ambulatory medical device includes a sensorconfigured to monitor a signal indicative of a physiological conditionof a patient over an extended period of time; a controller operativelycoupled to the sensor and configured to monitor the physiological signalover the extended period of time; a user interface; a datacommunications interface configured to establish a communication sessionwith a remote computing device; a remote access manager operativelycoupled to the controller and configured to monitor for a command from aremote computing device to establish the communication session betweenthe ambulatory medical device and the remote computing device; to causethe data communications interface to initiate the communication sessionin response to the command from the remote computing device; to receivefrom the remote computing device a request for at least one ofcontrolling a component of the ambulatory medical device and receivingan operational status of the ambulatory medical device via thecommunication session; to cause the user interface to display aninstruction indicative of the operational status of the ambulatorymedical device wherein the instruction comprises at least one ofdiscontinuing use of the device and contacting a remote technician wherethe operational status is critical operational status, and continuinguse of the device and contacting a remote technician where theoperational status is non-critical operational status.

In one example, an ambulatory medical device including a sensorconfigured to acquire a signal indicative of a physiological conditionof a patient; a controller operatively coupled to the sensor andconfigured to monitor the physiological signal, and to perform adiagnostic test; and a remote access manager operatively coupled to thecontroller and configured to monitor for a command from a remote systemto perform the diagnostic test, and to cause the controller to performthe diagnostic test in response to the command. In the device, theremote access manager may be further configured to transmit datarepresenting an operational status of the ambulatory medical device tothe remote system. The operational status of the controller may resultfrom performing the diagnostic test. The remote access manager may befurther configured to send the data representing the operational statusof the ambulatory medical device in real time or substantially in realtime. The data representing the operational status of the ambulatorymedical device may include a web page configured to present a virtualuser interface to the ambulatory medical device via a web browser.

The device may include a security manager operatively coupled to thecontroller and configured to limit an ability of the remote system tocontrol the ambulatory medical device. The device may include a deviceconfigured to administer a therapeutic treatment to a patient based onthe monitored physiological signal. The device may include a basestation configured to communicate with the controller, where the commandfrom the remote system is routed to the controller via the base station.The remote system may include the base station. The remote accessmanager may be further configured to detect an anomalous condition ofthe controller, and to transmit data representing an operational statusof the ambulatory medical device to the remote system in response todetecting the anomalous condition. The command from the remote system toperform the diagnostic test may include a text message received over afixed line telecommunications network or a mobile telecommunicationsnetwork. The ambulatory medical device may be configured to operate in alow power mode or a normal power mode, where the ambulatory medicaldevice consumes less power while operating in the low power mode thanwhile operating in the normal power mode. The remote access manager maybe further configured to periodically monitor for the command lessfrequently while the ambulatory medical device is operating in the lowpower mode than while the ambulatory medical device is operating in thenormal power mode.

The device may include a wearable medical device or a cardiac monitoringdevice. The ambulatory medical device may be configured to beoperatively coupled to a garment worn about a torso of a patient.

In one example, an ambulatory medical device includes a sensorconfigured to acquire a signal indicative of a physiological conditionof a patient; a controller operatively coupled to the sensor andconfigured to monitor the physiological signal, and to perform adiagnostic test; and a remote access manager operatively coupled to thecontroller and configured to monitor for a command to communicate with aremote system, and to establish a communication session with the remotesystem in response to the command. The remote access manager may befurther configured to cause the controller to perform the diagnostictest in response to receiving, from the remote system and via thecommunication session, a command to perform the diagnostic test. Theremote access manager may be further configured to transmit datarepresenting an operational status of the ambulatory medical device tothe remote system via the communication session. The data representingthe operational status of the ambulatory medical device may betransmitted in response to the command. The remote access manager may befurther configured to detect an anomalous condition of the controller,and to transmit the data representing the operational status of theambulatory medical device to the remote system via the communicationsession in response to detecting the anomalous condition. The remoteaccess manager may be further configured to transmit the datarepresenting the operational status of the ambulatory medical device inreal time or substantially in real time. The data representing theoperational status of the ambulatory medical device may include a webpage configured to present a virtual user interface to the ambulatorymedical device via a web browser.

The device may include a security manager operatively coupled to thecontroller and configured to limit an ability of the remote system tocontrol the ambulatory medical device. The device may include a sensorconfigured to detect a physiological signal. The device may include adevice configured to administer a therapeutic treatment to a patientbased on the monitored physiological signal. The device may include abase station configured to communicate with the controller, where thecommand from the remote system is routed to the controller via the basestation. The controller may include the base station. The command tocommunicate with the remote system may include a text message receivedover at least one of a fixed line telecommunications network and amobile telecommunications network. The device may include a wearablemedical device or a cardiac monitoring device. The ambulatory medicaldevice may be configured to be operatively coupled to a garment wornabout a torso of a patient.

In one example, an ambulatory medical device includes a sensorconfigured to acquire a signal indicative of a physiological conditionof a patient; a data communications interface; and a controlleroperatively coupled to the sensor and to the data communicationsinterface, the controller configured to monitor the physiologicalsignal, to receive a command to establish a communication session with aremote system via the data communications interface, to establish thecommunication session in response to receiving the command, and totransmit data representing an operational status of the ambulatorymedical device to the remote system via the communication session inresponse to receiving the command. The controller may be furtherconfigured to perform a diagnostic test in response to receiving, fromthe remote system and via the communication session, a command toperform the diagnostic test. The operational status of the ambulatorymedical device may result from performing the diagnostic test. Thedevice may include a security manager configured to limit control of theambulatory medical device by the remote system via the datacommunications interface. The ambulatory medical device may beconfigured to operate in a low power mode or a normal power mode, wherethe ambulatory medical device consumes less power while operating in thelow power mode than while operating in the normal power mode. The datacommunications interface may be configured to be operable in the normalpower mode and inoperable in the low power mode. The controller may befurther configured to periodically monitor for the command lessfrequently while the ambulatory medical device is operating in the lowpower mode than while the ambulatory medical device is operating in thenormal power mode.

The device may include a device configured to administer a therapeutictreatment to a patient based on the monitored physiological signal. Thedevice may include a battery configured to provide power to the datacommunications interface or the controller. The device may include abase station configured to communicate with the controller, where thecommunication session with the remote system is routed via the datacommunications interface and the base station. The base station mayinclude the controller. The controller may be further configured todetect an anomalous condition, and to transmit the data representing theoperational status of the ambulatory medical device to the remote systemvia the communication session in response to detecting the anomalouscondition. The command to establish a communication session may includea text message received over at least one of a fixed linetelecommunications network and a mobile telecommunications network. Thecontroller may be further configured to send the data representing theoperational status of the ambulatory medical device in real time orsubstantially in real time. The data representing the operational statusof the ambulatory medical device may include a web page configured topresent a virtual user interface to the ambulatory medical device via aweb browser. The data communications interface may be assigned a fixedInternet Protocol (IP) address. The device may include a wearablemedical device or a cardiac monitoring device. The ambulatory medicaldevice may be configured to be operatively coupled to a garment wornabout a torso of a patient.

In one example, an ambulatory medical device includes a user interfacedisposed in the device; a data communications interface; and acontroller operatively coupled to the data communications interface andthe user interface, the controller configured to transmit, via the datacommunications interface, data representing an indication of theoperational status of the ambulatory medical device to a remote system.The user interface may be configured to provide the indication of theoperational status of the ambulatory medical device to a user. Theindication of the operational status of the ambulatory medical devicemay be independent of the user interface. The user interface may includea text display, a graphics display, an input switch, a touch-sensitivescreen, an indicator lamp, or an enunciator. The controller may befurther configured to generate the operational status at least in partby executing a diagnostic test in response to receiving, from the remotesystem and via the data communications interface, a command to performthe diagnostic test. The diagnostic test may be executed without anyuser input via the user interface. The user interface may include a userinput element configured to control an operational function of theambulatory medical device, and the controller may be further configuredperform the operational function only in response to actuation of theuser input element of the user interface. The user interface may includea first user input element and a second user input element, the firstuser input element configured to control a first operational function ofthe ambulatory medical device, the second user input element configuredto control a second operational function of the ambulatory medicaldevice, and the controller may be further configured to reconfigure theuser interface to cause the first user input element to control thesecond operational function instead of the first operational function.The controller may be configured to receive, from the remote system andvia the data communications interface, a command to reconfigure the userinterface. The second user input element may be in an anomalouscondition. The first user input element and the second user inputelement may be an electrical switch, an acoustic-to-electric transducer,a photodetector, or a soft input of a touchscreen device.

The device may include a sensor configured to detect a signal indicativeof a physiological condition of a patient. The device may include adevice configured to administer a therapeutic treatment to a patient.The device may include a battery configured to provide power to thecontroller, the user interface, or the data communications interface.The device may include a sensor configured to acquire a signalindicative of a physiological condition of a patient. The controller maybe configured to monitor the physiological signal.

The device may include a device configured to administer a therapeutictreatment to a patient based on the monitored physiological signal.

Still other aspects, examples and advantages of these aspects andexamples, are discussed in detail below. Moreover, it is to beunderstood that both the foregoing information and the followingdetailed description are merely illustrative examples of various aspectsand features, and are intended to provide an overview or framework forunderstanding the nature and character of the claimed aspects andexamples. Any example or feature disclosed herein may be combined withany other example or feature. References to different examples are notnecessarily mutually exclusive and are intended to indicate that aparticular feature, structure, or characteristic described in connectionwith the example may be included in at least one example. Theappearances of such terms herein are not necessarily all referring tothe same example.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of at least one example are discussed below withreference to the accompanying figures, which are not intended to bedrawn to scale. The figures are included to provide an illustration anda further understanding of the various aspects and examples, and areincorporated in and constitute a part of this specification, but are notintended as a definition of the limits of any particular example. Thedrawings, together with the remainder of the specification, serve toexplain principles and operations of the described and claimed aspectsand examples. In the figures, each identical or nearly identicalcomponent that is illustrated in various figures is represented by alike numeral. For purposes of clarity, not every component may belabeled in every figure.

FIG. 1 illustrates an example medical device, in accordance with anexample of the present disclosure.

FIGS. 2A and 2B illustrate an example of a medical device controller, inaccordance with an example of the present disclosure.

FIG. 3 illustrates the controller of FIGS. 2A and 2B, and an examplebase station, in accordance with an example of the present disclosure.

FIG. 4 shows a schematic of an example of the medical device controllerof FIGS. 1, 2A, 2B, and 3, in accordance with an example of the presentdisclosure.

FIG. 5 shows an example user interface, in accordance with an example ofthe present disclosure.

FIG. 6 shows another example user interface, in accordance with anexample of the present disclosure.

FIG. 7 shows an example system, in accordance with various examples ofthe present disclosure.

FIG. 8 shows an example device diagnostic test process flow that can beused in conjunction with a medical device, in accordance with an exampleof the present disclosure.

FIG. 9 shows a flow diagram of an example methodology for remotelycontrolling or determining the status of a medical device, in accordancewith various examples of the present disclosure.

FIG. 10 shows several screen shots of an example training module for amedical device, in accordance with an example of the present disclosure.

FIG. 11 shows example screens displayed on a medical device, inaccordance with an example of the present disclosure.

FIG. 12 shows an example system involving a remote computing device, inaccordance with various examples of the present disclosure.

FIG. 13 shows example interface processes executed on a medical devicecontroller and a remote computing device, in accordance with variousexamples of the present disclosure.

DETAILED DESCRIPTION

Techniques for remotely controlling and/or determining the status of anambulatory medical device are disclosed herein. For example, a remoteperson may affect the behavior of the medical device in real-time orsubstantially in real-time by performing one or more actions at a remoteserver resulting in interrogation and/or dynamic changes on the medicaldevice. These techniques provide interested persons with the ability toremotely retrieve, from the device, information regarding theoperational status of the device, as well as the ability to remotely andsecurely control certain functions and operations of the device. Suchinterested persons may include, for example, technical supportpersonnel, medical professionals, or anyone other than the patient usingthe device. In some implementations, for example, a technician who isnot at the patient's location may remotely and directly access thedevice for troubleshooting purposes during a technical assistance callwith the patient. In these implementations, the technician may remotelycommand the device to perform one or more actions.

For instance, according to an example, a system for remotely controllingand determining a status of an ambulatory medical device includes aremote system connected, at least occasionally, to the device via a datacommunications network. A technician, who provides operational andtroubleshooting assistance to a patient using the device, can use thesystem to remotely interact with the device. Such interactions mayinclude, for example, viewing the operational status of the device,issuing commands to the device to resolve an intermittent problem withthe device, resetting the device, retrieving information from thedevice, remotely viewing a local user interface of the device, remotelyperforming firmware and software updates, upgrades, or applying patches,remotely downloading and/or applying updates to underlying treatmentand/or monitoring parameters, remotely changing threshold values forcertain underlying treatment and/or monitoring parameters, or remotelyperforming other functions relating to the operation of the device. Suchinteractions may be performed in real-time or substantially inreal-time, for example, while the patient is on the phone with thetechnician. In this manner, the technician can communicate directly withthe patient via a telephone or Internet telephony whilecontemporaneously providing technical assistance via the remote system.For example, the technician may ask the patient to describe the behaviorof the medical device or to press a button on the controller whilespeaking with the patient by telephone.

The ambulatory medical device includes a medical device controllerconfigured to transmit data to, and receive data from, the remote systemvia the network. Such data may, for example, include a command toperform a diagnostic test on the device, a request to establish acommunication session with the remote system, a command to reconfigurethe user interface of the ambulatory medical device, data representingan operational status of the device, and other data representing controland monitoring functions of the device, such as variously described inthis disclosure. The remote system can include a remote user interfaceand a web browser or other application configured to render at least aportion of the remote user interface.

Examples of the methods and systems discussed herein are not limited inapplication to the details of construction and the arrangement ofcomponents set forth in the following description or illustrated in theaccompanying drawings. The methods and systems are capable ofimplementation in other examples and of being practiced or of beingcarried out in various ways. Examples of specific implementations areprovided herein for illustrative purposes only and are not intended tobe limiting. In particular, acts, components, elements and featuresdiscussed in connection with any one or more examples are not intendedto be excluded from a similar role in any other examples.

Also, the phraseology and terminology used herein is for the purpose ofdescription and should not be regarded as limiting. Any references toexamples, components, elements or acts of the systems and methods hereinreferred to in the singular may also embrace examples including aplurality, and any references in plural to any example, component,element or act herein may also embrace examples including only asingularity. References in the singular or plural form are not intendedto limit the presently disclosed systems or methods, their components,acts, or elements. The use herein of “including,” “comprising,”“having,” “containing,” “involving,” and variations thereof is meant toencompass the items listed thereafter and equivalents thereof as well asadditional items. References to “or” may be construed as inclusive sothat any terms described using “or” may indicate any of a single, morethan one, and all of the described terms. In addition, in the event ofinconsistent usages of terms between this document and documentsincorporated herein by reference, the term usage in the incorporatedreferences is supplementary to that of this document; for irreconcilableinconsistencies, the term usage in this document controls.

Example Medical Devices

According to various examples, an ambulatory medical device isconfigured to enable remote retrieval of information from the device,remote control of the device, and remote diagnostic testing of thedevice. In some examples, this ambulatory medical device is configuredto monitor a signal indicative of a physiological condition of a patientand, in some implementations, provide a therapeutic treatment to thepatient based at least in part on the signal. Such remote interactionsas described herein may be configured to affect changes to the manner inwhich the device monitors and/or provides treatment to the patient. Forinstance, the medical device may be configured to monitor data acquiredfrom a patient via one or more sensors (e.g., electrocardiograph (ECG)data, heart sounds, respiration, breath sounds, tissue fluids, lungfluids, lung sounds, chest movements, and/or cardiopulmonary anomalies),detect an anomaly in the data, and provide a response to the detectedanomaly. Such a response can include providing an audible or visualsignal to the patient (e.g., sounding an alarm tone, illuminating awarning lamp, sounding a recorded or artificially generated voicecommand), displaying patient instructions, contacting a medical provideror emergency services personnel, or automatically administering atherapeutic treatment to the patient. In various implementations, themedical device is configured to monitor other patient parametersincluding but not limited to blood pressure, glucose levels, weight,blood oxygen, tissue fluid levels, etc. The remote interactions providedfor below would allow for an authorized remote person to effect changesto the one or more aspects of the medical device as described above,including, for example, to dynamically effect changes to underlyingmonitoring and/or treatment parameters, effect software changes, and/orprovide technical assistance.

In some examples, the ambulatory medical device is an external medicaldevice. External medical devices as described herein may be incontrasted with internal devices, such as implantable medical devices.For example, the ambulatory medical devices as described herein may becapable of continuous, substantially continuous, long-term and/orextended monitoring of a patient or wear by, or attachment or connectionto the patient. In some cases, ambulatory medical devices can be wornby, attached or otherwise connected to a patient without substantialinterruption for a certain period of time. In some cases, suchambulatory medical devices can be worn by, attached or otherwiseconnected to a patient for several hours, several days, several weeks,or longer. For example, the ambulatory device may be configured forsubstantially continuous monitoring and/or treatment over variousperiods of time, including at least a 24 hour period, at least a week,and at least a month. For example, such medical devices can includemonitoring and/or treatment devices configured to continuously monitor apatient for certain medical conditions for extended periods of time, forexample, for over 4 hours (e.g. treatment and monitoring devices such assleep apnea devices), over 12 hours (e.g. treatment and/or monitoringdevices such as mobile cardiac monitoring devices, wearabledefibrillator devices, etc.), and including for substantially continuousmonitoring over time periods over 24 hours or even several days. Suchdevices may monitor the patient substantially continuously, aside fromperiods during which the patient may periodically remove the device,such as for showering, refitting, changing a component of the device,etc.

In some examples, the ambulatory medical device, such as disclosedherein can be used as a cardiac monitor in certain cardiac monitoringapplications, such as holter monitoring, mobile cardiac telemetry (MCT)and/or continuous event monitoring (CEM) applications. The cardiacmonitor may be configured to be operatively coupled to one or morephysiological sensors for monitoring the patient. For example, suchsensors may include ECG sensors, heart sounds sensors, RF-based fluidmonitoring sensors, etc. For example, the ECG sensors may includeadhesively-attached electrodes that are configured to attach to thepatient's skin. In some instances, the ambulatory medical devices cancarry out monitoring in periodic or aperiodic time intervals or times.For example, the monitoring during intervals or times can be triggeredby a user action, a predefined monitoring condition, or another event.

The duration between the periodic or aperiodic intervals or times can beuser-configurable or established by the manufacturer of the device or aqualified professional (e.g., a medical technician, pharmacist, nurse,or doctor). In some examples, the patient can interact with a userinterface disposed on the cardiac monitor to identify a patient symptom.For example, such a user interface can comprise a drop down menu orcheck list that allows the patient to select a particular symptom from alist of alternatives. Options for patient systems can comprise one ormore of: feeling a skipped beat, shortness of breath, light headedness,racing heart rate, fatigue, fainting, chest discomfort, weakness,dizziness, and/or giddiness. In addition, the patient can select a levelof activity (e.g., light activity, moderate activity, rigorous activity,etc.) that he or she was performing when the symptom occurred. In someexamples, in response to the selection by the patient, a cardiac eventdetector (e.g., cardiac event detector 426 of FIG. 4) can cause aportion of patient physiological information (e.g., in the form of acardiac signal) to be captured for a length of time that is based onwhen the symptom was experienced.

In some examples, the ambulatory medical device is capable of, anddesigned for, moving with the patient as the patient goes about his orher normal routine. For example, the ambulatory medical device may beconfigured as a wearable defibrillator, such as the LifeVest® wearabledefibrillator available from ZOLL® Medical Corporation of Chelmsford,Mass.

FIG. 1 illustrates an example medical device 100 that is external,ambulatory, and wearable by a patient 102. The example medical device100 is configured to enable a technician or other user to remotelymonitor the device, control the device, and/or perform diagnostic testson the device. The medical device 100 can include one or more of thefollowing: a garment 110, one or more sensing electrodes 112 (e.g., ECGelectrodes), one or more therapy electrodes 114, a monitor or a medicaldevice controller 120, a connection pod 130, a patient interface pod140, a belt 150, or any combination of these. In some examples, at leastsome of the components of the wearable medical device 100 are configuredto be affixed to the garment 110 (or in some embodiments, permanentlyintegrated into the garment 110), which can be worn about the patient'storso. The controller 120 can be operatively coupled to the sensingelectrodes 112, which may be affixed to the garment 110, e.g., assembledinto the garment 110. In some implementations, the sensing electrodes112 may be permanently integrated into the garment 110. The controller120 is operatively coupled to the therapy electrodes 114. For example,the therapy electrodes 114 may also be assembled into the garment 110,or, in some implementations, the therapy electrodes 114 may bepermanently integrated into the garment 110.

Component configurations other than those shown in FIG. 1 are possible.For example, the sensing electrodes 112 are configured to be attached atvarious positions about the body of the patient 102. The sensingelectrodes 112 can be operatively coupled to the medical devicecontroller 120 through the connection pod 130. In some implementations,the sensing electrodes 112, the therapy electrodes 114, or both, may beadhesively attached to the patient. In an implementation, the sensingelectrodes 112 and therapy electrodes 114 may be included on a singleintegrated patch and adhesively applied to the patient's body.

The sensing electrodes 112 are configured to detect one or more cardiacsignals. Examples of such signals include ECG signals, heart sounds,and/or other sensed cardiac physiological signals from the patient. Theconnection pod 130 can, in some examples, include a signal processorconfigured to amplify, filter, and digitize these cardiac signals priorto transmitting the cardiac signals to the controller 120. One or moretherapy electrodes 114 are configured to deliver one or more therapeuticdefibrillating shocks to the body of the patient when the medical device100 determines that such treatment is warranted based on the signalsdetected by the sensing electrodes 112 and processed by the controller120.

One or more remote interactions may be configured to effect changes tothresholds for discriminating ECG signals in noisy environments. Forinstance, if a patient is encountering frequent false positives, theremote technician may be able to change device noise discriminationthresholds by establishing a remote secure communication session withthe device. In some implementations, a machine learning based system maybe implemented to determine whether an abnormal heart rhythm isventricular tachycardia (VT) or ventricular fibrillation (VF).Accordingly, a method for distinguishing a cardiac event from noise inan ECG signal includes obtaining an indicating from a digital signalprocessing module that a cardiac event has occurred, obtained the ECGsignal corresponding to the cardiac event from a memory, determining afeature of the ECG signal (e.g., a power spectral density or PSD) of theECG signal and determining an ECG-derived score based on the PSD andcorresponding to the ECG signal. A predetermined threshold can beautomatically derived based on the machine learning system and used tocompare against the ECG-derived score. Such a threshold may be remotelyconfigurable via the secure remote communication session. Furtherdetails regarding noise discrimination are described in U.S. PublicationNo. 20160000349 (the '349 publication), entitled “SYSTEM AND METHOD FORDISTINGUISHING A CARDIAC EVENT FROM NOISE IN AN ELECTROCARDIOGRAM (ECG)SIGNAL” and filed on Jul. 6, 2015, which is hereby incorporated hereinby reference in its entirety.

Example Medical Device Controller

FIGS. 2A and 2B illustrate an example of the controller 120 of FIG. 1,in accordance with an example of the present disclosure. The controller120 includes a port 202, a speaker 204, one or more user interfaceelements, such as a response button 210 and a display 220, a housing206, and a battery 212 or other power source. The port 202 is configuredto removably connect sensing devices (e.g., sensing electrodes 112)and/or therapeutic devices (e.g., therapy electrodes 114) to thecontroller 120. The speaker 204 is configured to communicate informationto the patient, a caregiver, or other bystander, including audiblealarms and alerts. The controller 120 and/or the patient interface pod140 can include one or more response buttons 210, which the patient canpress to respond to the device. The user interface elements canadditionally or alternatively be configured to provide device statusinformation, diagnostic information about the device, instructions, andother related information to the patient, caregiver, or bystander. Insome implementations, the user input elements may, for example, includean electrical switch, an acoustic-to-electric transducer, aphotodetector, a soft or virtual input of a touchscreen device, or anycombination of these. The patient or caregiver can interact with thetouch screen 220 or, as described below, the patient interface pod 140,to control the medical device 100. As shown in FIG. 1, the wearablemedical device 100 can, in some examples, include the patient interfacepod 140, which can be coupled to the medical device controller 120. Inone example, the patient interface pod 140 can be electrically coupledby a cable to the controller 120. In another example, the pod 140 can bewirelessly coupled (e.g., via Bluetooth) to the controller 120. Thepatient interface pod 140 can, in some examples, include patientinterface elements, such as a speaker, a microphone responsive topatient voice input, a display, an interactive touch screen responsiveto patient touch input, physical buttons, or any combination of these.In addition to, or instead of, the touch screen 220 of the controller120, the controller 120 may interact with the patient (e.g., receivepatient input or provide information to the patient as described herein)via patient interface pod 140 (shown in FIG. 1). The patient interfacepod 140 may take other forms and include additional functionality. Forinstance, the patient interface pod 140 may be implemented on asmartphone, tablet, or other mobile device carried by the patient. Inanother example, the patient interface pod 140 may be worn as a watchabout the wrist of the patient, or as a band about an upper arm of thepatient.

FIG. 3 illustrates the controller 120 of FIGS. 2A and 2B, and an examplebase station 300, in accordance with an example of the presentdisclosure. In some examples, the controller 120 is configured tocommunicate with the base station 300. The base station 300 includes anantenna 302, a battery charging bay 304, one or more buttons 306, aspeaker 308, a display 310, and one or more communication interfaces312, 314, and 316. The base station 300 can communicate with thecontroller 120 via, for example, wireless communication connection 318,e.g., BLUETOOTH, Wireless USB, ZigBee, and Wireless Ethernet. Theinformation received by the base station 300 may be communicated over awired or wireless communication network shortly after it is received bythe base station 300, or alternatively, may be stored in a memory of thebase station 300 and communicated over the network at a later time. Forexample, such information may be part of a remote communication sessionestablished by a remote person to establish real time or substantiallyreal-time interaction with the device. In some examples, the basestation 300 is capable of charging the removable battery 212 for thecontroller 120.

In some examples, the controller 120 may alternatively or in addition bein communication 317 with a mobile remote computing device 311 (e.g., amobile phone, smart phone, tablet, or other personal device). Asdescribed in further detail below, a remote communication session 317can be established between the controller 120 and the mobile remotecomputing device 311. A remote technician may perform diagnostics on themedical device controller 120 via the mobile remote computing device317. For example, the technician may cause a remote server to send oneor more instructions (e.g., in the form on action scripts) to the mobileremote computing device 317. The mobile remote computing device 317 maythen be configured to control the controller 120 in a manner prescribedby the remote technician in accordance with the instructions. The mobileremote computing device 317 can communicate with the controller 120 via,for example, wireless communication connection 318, e.g., BLUETOOTH,Wireless USB, ZigBee, and Wireless Ethernet. The information received bythe mobile remote computing device 317 from the controller 120 may becommunicated over a wired or wireless communication network shortlyafter it is received by the mobile remote computing device 317, oralternatively, may be stored in a memory of the mobile remote computingdevice 317 and communicated over the network at a later time. Forexample, such information may be part of a remote communication sessionestablished by a remote person to establish real time or substantiallyreal-time interaction with the device.

FIG. 4 shows a schematic of an example of the medical device controller120 of FIGS. 1, 2A, 2B, and 3. In some examples, the medical devicecontroller 120 may be adapted as a cardiac monitor as described above.The controller 120 includes a sensor interface 412, at least oneprocessor 418, a device diagnostic component 414, an optional therapydelivery interface 402, data storage 404 (which may include operationaldata store 430), a data communications interface 406, a user interface408, a remote access manager 428, a security manager 440, and thebattery 312.

In some implementations, the controller 120 includes one or morecomputer processors 418 that are each configured to execute a series ofinstructions that result in manipulated data and/or control theoperation of the other components of the controller 120. In someimplementations, the processor 418 can be configured to include theremote access manager 428 or control the actions of the remote accessmanager 428 described in further detail below. In some implementations,when executing a process such as provided herein (e.g., FIGS. 9 and 13),the processor 418 is configured to make specific logic-baseddeterminations based on input data received, and further capable ofproviding one or more outputs that can be used to control or otherwiseinform subsequent processing to be carried out by the processor 418and/or other processors or circuitry with which processor 418 iscommunicatively coupled. Thus, the processor 418 reacts to specificinput stimulus in a specific way and generates a corresponding outputbased on that input stimulus. In this sense, the structure of processor418 according to one example is defined by the flow chart shown in FIG.9. In some example cases, the processor 418 proceeds through a sequenceof logical transitions in which various internal register states and/orother bit cell states internal or external to the processor 418 may beset to logic high or logic low. This specific sequence of logictransitions is determined by the state of electrical input signals tothe processor 418 and a special-purpose structure is effectively assumedby the processor 418 when executing each software instruction of thesoftware process shown in, for example, FIGS. 9 and 13. Specifically,those instructions anticipate the various stimuli to be received andchange the implicated memory states accordingly. In this way, theprocessor 418 may generate and store or otherwise provide outputsignals. It is appreciated that the processor 418, during execution of aprocess, is capable of processing specific input signals and renderingspecific output signals based on the one or more logic operationsperformed during execution of each software instruction. As referred toherein, the processor 418 is configured to execute a function wheresoftware is stored in a data store coupled to the processor 418 that isconfigured to cause the processor 418 to proceed through a sequence ofvarious logic decisions that result in the function being executed.

In some examples, the controller 120 includes an embedded operatingsystem and features that provide relational database functionality,touch screen display drivers, audio generation, BLUETOOTH wirelessnetworking, networking security and firewalling, a lightweight webserver and data encryption services.

In some examples, the controller 120 is configured to receive a requestto establish a communication session with a remote system via the datacommunications interface 406, and to establish the communication sessionin response to receiving the request without any interaction by thepatient. In some implementations, the patient may be prompted toauthorize the initiation of the session. For instance, the patient maybe prompted to enter a passphase or provide other such form ofauthorization. For example, if a remote technician wishes to establish acommunication session with the medical device 100 for troubleshootingpurposes, the technician may cause the remote system to send acommunications session request to the device 100. The device, in turn,may receive the request substantially immediately after the request issent, or at some future point in time, and open the communicationsession automatically. After the communication session has beenestablished in response to receiving the request, the controller maytransmit data representing an operational status of the ambulatorymedical device to the remote system via the communication session.

The sensor interface 412 can be coupled to any one or combination ofsensors to receive a signal indicative a physiological condition of thepatient. For example, the sensor interface 412 may be coupled to one ormore sensing devices including sensing electrodes 428 (e.g., sensingelectrodes 112 of FIG. 1). The therapy delivery interface 402 (ifincluded) can be coupled to one or more electrodes that provide therapyto the patient including, for example, one or more defibrillationelectrodes 420, pacing electrodes 422, and/or TENS electrodes 424. Insome examples, the controller 120 includes a cardiac event detector 426to monitor the cardiac activity of the patient and identify cardiacevents experienced by the patient based on the physiological signal. Inresponse to identifying certain cardiac events, the controller 120 isconfigured to administer a therapeutic treatment to the patient via thetherapy delivery interface 402, such as described above.

In some examples, the data communications interface 406 is configured tofacilitate the communication of data and information over a datacommunications network between the controller 120 and one or more otherdevices or entities (e.g., a remote system or a technician providingremote assistance to the patient). In some examples, the datacommunications interface 406 is configured to communicate with a remotesystem (e.g., a computer server that may be accessed via a telephonynetwork, a wide area network, or the Internet) or other electronicdevice, where a technician can access information related to the medicaldevice 100 or with a base station (e.g., the base station 200) that isassociated (e.g., paired) with the controller 120. According to anexample, the data communications interface 406 is configured to providea data pathway between the remote system and certain components of thecontroller 120, including the remote access manager 428. This pathwaycan directly link the controller 120 to the remote system, or thepathway can be routed from the controller 120 to the remote system viathe base station 300. In some examples, at least a portion of thepathway includes a BLUETOOTH or other wireless connection between thecontroller 120 and the base station 300.

In some examples, the user interface 408 includes one or more physicalinterface elements such as user input elements 408 a, 408 b, displays,lamps and indicators 408 c, enunciators and audio speakers 408 d, andother input devices, output devices, and combination input/outputdevices. These user interface elements may render visual, audio, and/ortactile content, including content relating to the device health status.For instance, in some examples, the user interface 408 includes amicrophone, the speaker 204, the display 220, and the response buttons210, as shown in FIGS. 2A and 2B. In some examples, the user interface408 includes one or more electrical switches, one or moreacoustic-to-electrical transducers, one or more photodetectors, and oneor more soft or virtual user input elements associated with atouch-sensitive screen device. Thus the user interface 408 may receiveinput or provide output, thereby enabling a user to interface with thecontroller 120. FIG. 6 shows another example user interface 408, whichis described in further detail below.

Example Remote Access Manager

According to some examples, the remote access manager 428 is configuredto monitor for a command from a remote system to perform a diagnostictest on the ambulatory medical device 100 and to cause the controller120 to perform the diagnostic test in response to the command. Forinstance, in one example, the remote access manager 428 is configured toreceive commands for the controller 120 from the remote system via thedata communications interface 406. In examples, the remote system may bea remote server administered by a monitoring service, a health careorganization, or other entity. For example, the remote system may beimplemented as a local area network, a private network, a virtualprivate network, or server-based networked computer system containingone or more networked devices (e.g., a computer, smartphone, tablet orother workstation).

According to some examples, the remote access manager 428 is configuredto monitor for a request to communicate with a remote system and toestablish a communication session with the remote system in response tothe request. For instance, in one example, the remote access manager 428is configured to send data from the controller 120 to the remote systemvia the data communications interface 406.

In some examples, commands received by the controller 120 or the remoteaccess manager 428, data generated by the device 100, or otherinformation related to the device 100 may be temporarily stored in amemory device of the base station 300 (e.g., via BLUETOOTH, WiFi, orother wireless communication channel). For example, the base station 300may temporarily store commands, messages, and other information whilethe controller 120 is not within wireless communication range of thebase station 300. In one example, such commands, messages, and otherinformation may be stored in the form of action files in a memory of thebase station 300. An action file may specify a sequence of instructionsconfigured to be automatically executed by the controller 120.Similarly, the controller 120 may connect to the base station 300 andupload information collected by the device during its operation.

For instance, information that is uploaded from or downloaded to theambulatory medical device via a communication session may vary dependingon the type of medical device. For example, a cardiac monitor mayexchange information relating to cardiac monitoring thresholds asdescribed below. For example, a defibrillator may exchange informationrelating to treatment thresholds, such as shock energy levels, number ofpulses, duration of pulses, etc. In general, such information caninclude patient information, device status information, and otheroperational data. Patient information in this context may include ECGinformation, such as atrial fibrillation (AF), changes in QRS (e.g.:width, height, or other such parameter), change in (s-t) t-wave,ventricular tachycardia (VT), ventricular fibrillation (VF), tachycardia(e.g., above a specified threshold), bradycardia (e.g., heart ratefalling below a specified threshold, significant pauses (e.g., triggeredby a predetermined threshold), and pre-ventricular contractions (PVCs).For example, when a PVC count threshold is exceeded, the patientinformation may be uploaded to an analyst for further review byactivating a user interface element on the device. Patient informationmay include patient reported symptom information, for example, when thepatient reports (e.g., by activation of a user interface element)dizziness, palpitations, chest pain, etc. Patient information mayinclude a non-treatable rhythm, e.g., a rhythm detected by the devicebut not treatable by the device. For example, a normal ECG may beaffected by noise, which causes the data to be flagged for furtherreview by an analyst. In some examples, the ECG may include PVCs, whichmay also cause the data to be flagged for further review by an analyst.In such cases, the analyst may use the remote communication session toreview the patient's ECG and establish the nature of the issue flaggedby the device. The analyst may then cause an ECG template (e.g., atemplate having a form of PVC matter that the analyst selects based onhis or her review) to be downloaded to the device via the remotecommunication session. The device may use the template to filter out ordisregard certain noise or PVC patterns. In cases where the analystre-characterizes the template, the generated template can be downloadedto the device and activated dynamically via the remote communicationsession without patient intervention. Other patient information that maybe affected in a similar manner includes change in patient fluid levels,respiration information, accelerometer-detected patient falls, walk testactivation and data, cardiac sounds or measures such as an S3, S4, orprolonged electromechanical activation times (EMAT). The data may beconfigured to be exchanged on a continuous, periodic, or aperiodicbasis.

After the controller 120 enters the wireless communication range of thebase station 300, a wireless connection can be established and theinformation stored on the base station 300 can be transmitted to thecontroller 120. Similarly, information can be temporarily stored on thebase station 300 while no data connection is present between the basestation 300 and the remote system. After the base station 300establishes such a data connection, the information stored on the basestation 300 can be transmitted to the remote system. In this sense, somedata communications between the controller 120 and the remote system areasynchronous (i.e., not contemporaneous), but instead are buffered onthe base station 300 until the corresponding data communicationsconnections are established and the information transfer can becompleted.

In some cases, a doctor or an external monitoring service may activatethe remote communication session to request patient data, as describedabove, or device data. For example, the server receiving suchinformation may be configured to perform analysis on the returned data,including study trends, and provide one or more reporting functions topredetermined end-users and/or devices. For example, reports can begenerated in specified intervals (e.g., weekly, daily, or hourly).Reports may also be generated based on onset of certain events (e.g.,cardiac events described above).

The doctor or external monitoring service may use the remotecommunication session to cause instructions to be sent to the patient.In some examples, the doctor or external monitoring service may alsoremotely cause the device changes to the patient's monitoringparameters, treatment regimen, or other device configurations. As anillustration, a patient wearing a cardiac monitor or a defibrillator maybe sent a set of customized instructions (e.g., personalized to theparticular patient) to perform a walk test. Such instructions mayinclude reminders to take medication prior to performing the activity,how to perform the activity, pace and speed information, among others,and may be delivered in a preferred language of the patient. Inaddition, a doctor may indicate that one or more physiologicalparameters of the patient, e.g., heart rate, ECG, and respirationsounds, is to be monitored during the performance of the test. Forexample, the device may permit a doctor or other healthcare provider toremotely monitor one or more of the physiological parameters of thepatient in real time or near real time while the patient is performing aphysical activity while wearing the device, such as a walk test. Themonitoring may be activated manually by the patient using the userinterface of the device, or remotely activated by sending a command tothe device. If the monitoring is remotely activated, the patient may beasked to acknowledge the monitoring by activating a user interfaceelement (e.g., press a button or touch the screen) before the remotemonitoring begins, or the patient may be notified of the monitoring bydisplaying a message on the user interface and/or sounding an audiblecue. During the monitoring, the device may upload data representing themonitored parameters to the remote server as the data is collected. Thedoctor may also indicate that if certain thresholds are transgressed(e.g., heart rate exceeds 130 beats per minute), then the patient may beinstructed to pause, suspend, or stop the activity.

In another illustration, a patient wearing a cardiac monitor or adefibrillator may call technical support to report a problem withelectrode noise and false alerts. The technician may use a reportcommunication session as described herein to access the patient'sdevice. In real-time or substantially real-time, the technician mayinstruct the patient to adjust his or her electrodes and view thechanges in signals as the patient is following the instructions.

In some examples, the remote access manager 428 is configured to receivefrom a remote system a request to configure or re-configure the medicaldevice in real time or in substantially real-time. A technician or otherauthorized entity send one or more commands, messages, or otherinstructions to the remote access manager 428 to cause the medicaldevice to initiate or re-initiate the device with data pertaining to thepatient associated or to be associated with the device. For example,cardiac devices such as cardiac monitors and defibrillators may beremotely configured with certain initial information. Such informationmay include patient-specific information, e.g. the patient's name, dateof birth, a unique identifier, a start date for device use, an estimatedlength of use of the device, and one or more reasons for the devicebeing prescribed to the patient (e.g., cardiac arrest due to VT/VF,familial or inherited health condition with sudden cardiac arrest risk,myocardial infarction (MI) with an ejection fraction (EF) of less than apredetermined value, say, 35%, Ischemic Cardiomyopathy (NICM), or otherDilated Cardiomyopathy (DCM) with EF<35%, among others). In someimplementations, the remotely provided configuration information canalso include threshold values for one or more parameters. For adefibrillator or other cardiac therapeutic device certain thresholdvalues may be provided: a VT threshold value (e.g., 150 bpm), a VFthreshold value (e.g., 200 bpm), and values for one or more treatmentpulses (e.g., 75 Joules for a first pulse, 100 joules for a secondpulse, 125 joules for a third pulse, and so on). The patient-specificand/or device configuration information can be remotely reconfiguredover the communication session. As such, if any of the information,e.g., patient's details, dates and/or length of use, or other deviceconfiguration information such as VT threshold value, VF thresholdvalue, and/or treatment pulse energy levels needs to be changed, atechnician or reviewer can use the remote communication session toeffect the change on the medical device.

Example Security Manager

According to an example, the security manager 440 is configured to limitan ability of the remote system to control or obtain information fromthe ambulatory medical device 100. For example, the security manager 440may be configured to prevent the remote system from altering orotherwise affecting any critical device functions, such as treatmentparameters, critical device self-tests, and power management. Forinstance, the security manager 440 may be configured to intercept, andprevent the device from executing, certain commands that could powerdown the device or put the device into a mode that prevents the devicefrom administering a treatment to the patient, detecting a physiologicalsignal of the patient, or disabling any alarms. In another example, thesecurity manager 440 may be configured to prevent private information(e.g., certain data relating to the physiological signal of the patient,certain patient health information, or the identity or location of thepatient) from being transmitted to the remote system. In some examples,the security manager 440 can intercept certain commands and other datafrom the remote access manager 428 before such commands and data reachor affect other components of the device (e.g., the cardiac eventdetector 426, the device diagnostic component 414, the sensor interface412, and the therapy delivery interface 402), effectively acting as afirewall between those components and the remote access manager 428. Insome examples, some or all aspects of the security manager 440 can beintegrated with the remote access manager 428 or the data communicationsinterface 406.

Example Device Diagnostic Component

According to an example, the device diagnostic component 414 isconfigured to receive a request to perform a diagnostic test on theambulatory medical device 100, to query data sources within thecontroller 120 for operational status information, to perform normaloperations and collect the results of such operations, to report ortransmit the operational status information or results, or anycombination of these. The device diagnostic component 414 may, forexample, be configured to execute one or more tests that evaluate theoperational integrity or state of various components, circuits, and/orsubsystems of the ambulatory medical device 100, including, for example,the controller 120. In some cases, the device diagnostic component 414is configured to receive, from the remote system via the remote accessmanager 428, a command to execute a test. In response to receiving sucha command, the device diagnostic component 414 may execute one or moretests designed to reveal whether or not the device is operating asintended by the manufacturer. For example, the tests may be designed toevaluate whether certain components of the device 120, such as processor418, the data communications interface 406, the cardiac event detector426, the sensor interface 412, and the therapy delivery interface 402are functioning normally or abnormally, or to otherwise generateinformation describing the condition of the device. In some examples,the device diagnostic component 414 is configured to transmit datarepresenting the results of the tests, or data representing variousoperating states or conditions of the device 100, to the remote system,either in response to a request or command from the remote system or inresponse to another event, such as a change in state or operationalconditions (e.g., the activation of a function by the patient via theuser interface 408 or the activation of a function by the cardiac eventdetector 428). Other examples of the device diagnostic component 414 aredescribed in U.S. patent application Ser. No. 15/397,102, entitled“PATIENT ASSURANCE SYSTEM AND METHOD” and filed on Jan. 3, 2017, whichis incorporated herein by reference in its entirety.

In some examples, to identify the one or more data sources to query withrespect to remotely determining updated diagnostic information, theremote access manager 428 is configured to access one or more datastructures that identify data sources. These data structures may bestored in the operational data store 430, along with previouslygenerated device operational status information and results ofdiagnostic tests. In some examples, the one or more data structures thatidentify the data sources combine to form a table in memory storage(e.g., operational data store 430) that associates the data sources withone or more subsystems of the ambulatory medical device 100.

For example, the operational data store 430 may store identifiers ofdata sources in association with identifiers of the subsystems. Theoperational data store 430 can be configured to associate multiple datasources (e.g., one for each test executable by the device diagnosticcomponent 414) with subsystems of a medical device. More specifically,the store 430 can be configured to associate data sources with a monitorsubsystem, an electrode subsystem, a battery subsystem, a base stationsubsystem, a garment subsystem, and a communications subsystem. Thecomponents included in each of the subsystems may vary between examples.However, the monitor subsystem generally includes the controller 120 andits components, as illustrated in FIGS. 1, 2A, 2B, 3, and 4. In someexamples, the monitor subsystem includes a processing subsystem thatincludes the processor 418 and the data storage 404. The electrodesubsystem generally includes the therapy electrodes 114, the sensingelectrodes 112, the connection pod 130, and associated wires and cables,as illustrated in FIG. 1. The battery subsystem generally includes thebattery 212, as illustrated in FIGS. 2A and 2B. The base stationsubsystem generally includes the base station 300 and its components, asillustrated in FIG. 3. In some examples, the base station subsystemincludes a battery charger subsystem that includes a battery chargingcircuit. The garment subsystem generally includes the garment 110 andits components, as illustrated in FIG. 1. In some examples, theelectrode subsystem includes a gel deployment subsystem, sensingelectrode subsystem, a therapy electrode subsystem, and a signalacquisition and processing subsystem, which includes the connection pod130. In at least one of these examples, the gel deployment subsystem isconfigured to dispense impedance reducing gel on the patient's body. Insome examples, the monitor subsystem, the electrode subsystem, thegarment subsystem, and the battery subsystem include an energy storageand delivery subsystem that includes the battery 212, the therapydelivery interface 402, and the therapy electrodes 114. Thecommunications subsystem generally includes the network interface 406and/or communication components housed in the base station 300.

In some examples, one or more remotely triggered device diagnostic testsassociated with the monitor subsystem includes tests that validate theoperational integrity of processing elements (e.g., the processor 418),memory elements (e.g., the data storage 404), user interface elements(e.g., the user interface 408), and therapy deliver elements (e.g., thetherapy delivery interface 402). For instance, one or more remotelytriggered diagnostic tests associated with the monitor subsystem maycheck the capacitor charging circuit to verify the capacitors can becharged appropriately for delivery of one or more therapeuticdefibrillating and/or pacing pulses.

In some examples, the one or more remotely triggered diagnostic testsassociated with the electrode subsystem include tests that validate theoperational integrity of sensing electrodes (e.g., the sensingelectrodes 112), therapy electrodes (e.g., the therapy electrodes 114),the gel deployment subsystem, and/or a vibration box (e.g., part of theuser interface 408) located in a connection pod (e.g., the connectionpod 130). For instance, the one or more remotely triggered diagnostictests associated with the electrode subsystem may check to ensure thatthe electrode cables have not experienced tensile forces in excess of athreshold value and that the signal strength and impedance measured atthe electrodes in the electrode subsystem are within one or moreacceptable ranges.

For example, a combination of software and hardware tests may includemechanisms that simulate an input and read one or more resultingoutputs. The outputs may then be compared to a set of known good valuesand it is then determined if a component within the one or moresubsystems (e.g., the electrode subsystem) is malfunctioning or requirescalibration. For example, critical components on the electrode subsystemmay include accelerometer, gyro, heart sounds sensor, and analog frontend for receiving ECG and/or electrical signals from the patient. Thesoftware and/or hardware test circuitry may include signal generatorsfor generating test stimulus signals. Additional diagnostic tests aredescribed in U.S. application Ser. No. 15/073,923, entitled “SYSTEMS ANDMETHODS FOR TESTING A MEDICAL DEVICE” and filed on Mar. 18, 2016, whichis incorporated herein by reference in its entirety.

Example Local-Remote User Interfaces

FIG. 5 shows an example user interface 408 that can be implemented intothe ambulatory controller 120, in accordance with an example. In thisexample, the user interface 408 includes a display screen 502 configuredto display text and graphics generated at least in part by thecontroller 120. The display screen 502 can, in some examples, be atouch-sensitive display screen that is configured to detect a physicalcontact by a finger or other object. In such cases, the screen 502 maybe configured to display one or more virtual user input elements 504that are programmed to behave in the same manner as a physical userinput element, such as a button or switch. The user interface 408 caninclude, in some examples, one or more of such physical user inputelements 506 a and 506 b, in addition to or instead of the virtual userinput elements 504.

In some cases, the user interface 408 is configured to provide anindication of the operational status of the ambulatory medical device toa user. In some such cases, the indication of the operational status ofthe ambulatory medical device is independent of the user interface 408(e.g., the indication of the operational status may not be displayed tothe patient in the user interface due to a configuration settingpreventing such display or due to a failure of the user interface todisplay the operational status). In this manner, the remote system canobtain the operational status of the medical device even if the localuser interface is not contemporaneously displaying the status to thepatient.

In some cases, the controller 120 is configured to generate theoperational status at least in part by executing a diagnostic test inresponse to receiving, from the remote system and via the datacommunications interface, a command to perform the diagnostic test. Insome such cases, the diagnostic test is executed without any user inputvia the user interface 408.

In some cases, the user interface 408 includes one or more user inputelements, such as physical buttons 506 a, 506 b or virtual buttons 504on a touch screen 502. The user input elements are configured to controlvarious operational functions of the ambulatory medical device. In suchcases, the controller is configured perform the operational functionsonly in response to actuation of the corresponding user input element(s)of the user interface. For example, the controller may be configured tonot perform a given operational function in response to a remote commandor signal, or in response to the actuation of any other user inputelements of the user interface. Such a configuration may be desirable,for example, where the particular operational function is a criticalfunction that is designed to be activated only by certain inputs, suchas a dedicated button on the medical device, to prevent inadvertent orunintended activation by another user input element or remote command.As an illustration, the response buttons (506 a and 506 b) may beconfigured to cause a therapy to be delayed or suspended when thebuttons are held down together. In such a configuration, the therapycannot be delayed or suspended when only one of the two buttons is helddown or in response to a remote signal.

In some examples, the user input elements are configured to performother functions, such as selecting parameters, activating diagnostictests, displaying messages, activating audible alarms, or otherwiseinteracting with the device 100. In such examples, the functions of theuser input elements are not necessarily critical to the medicalcondition of the patient, and therefore may be remotely reconfigured viaa remote communication session as appropriate to perform criticalfunctions in the event that another user input element fails or becomesinoperative. In some examples, the technician can remotely activate anyof the user input elements without patient intervention, such as whenremotely troubleshooting the device 100.

FIG. 6 shows another example user interface 600, in accordance with anexample of the present disclosure. In this example, the user interface600 can be implemented in a web browser or other graphical userinterface application. For example, a web page may be configured topresent a virtual user interface 602 to the medical device via a webbrowser. At least a portion of the user interface 602 is configured tosubstantially replicate the user interface 408 of, for example, FIG. 5.

In some cases, the user interface 600 can be generated based on datareceived from the controller 120 via the remote access manager 428, suchas when the user interface 600 is connected to the remote system. Inthis manner, a technician can remotely view and access at least portionsof the user interface 408 on the device 100 via the user interface 600on the web browser.

As can be seen in FIG. 6, the user interface 600 can include an image ofthe display screen 502′ and the user input elements 504′ and 506′. Inoperation, the screen 502′ and the user input elements 504′ and 506′ canmimic the function and behavior of the corresponding screen 502 and userinput elements 504, 506 a, 506 b, such that a user can monitor orcontrol the device 100 remotely. For example, a remote technician may beable to view a sequence of screens corresponding to the sequence ofscreens being viewed by the patient on the device. To reduce thebandwidth utilized by the data communications interface, the device canbe configured to transmit a limited sequence of codes that efficientlyrepresent the information displayed on the screen (or incremental ordifferential changes in the information), rather than transmitting datarepresenting images of the entire screen on a pixel-by-pixel basis. Insuch cases, for example, the user interface 600 may include a virtualrepresentation of the user interface 408 generated from the codesequence. Such a virtual representation displayed on the user interface600 may be visually similar to the screen seen by the patient on theuser interface 408, but it will be understood that the user interface600 may not necessarily display a similar representation.

A user interface of a medical device may include a predetermined set ofinteractive screens displayed to the patient locally, or the technicianremotely, as the case may be, in accordance with device functionality.The patient or technician may navigate, or the device may automaticallyadvance, from one screen to the next based on a state of the device. Forexample, if the device is performing a diagnostic test that has multiplescreens of information and/or user interaction (e.g., a button toactivate a step within a multi-step operation, or to acknowledge thatthe patient or technician has read the information on the screen), thepatient or the technician may cause the device to display a differentscreen by pushing a button or remotely sending a command to advance tothe next screen, respectively.

A remote system having the user interface 600, as viewed by atechnician, may establish a communications session with the device viathe remote access manager 428 and view the same screen the patient iscurrently viewing or has recently been displayed to the patient, anotherrepresentation of the screen the patient is currently viewing or hasrecently been displayed to the patient, the status of the device 100, orother pertinent information about the operation and status of thedevice. The server may then cause substantially the same screen andstatus (or other another form of this information) to be displayed tothe remote technician based on this information so that the remotetechnician can work through a device issue while the patient is on thephone with the technician. For example, the user interface 600 of theremote system may display a visually similar representation of thescreen as seen by the patient, or the user interface 600 may displayinformation in a different form that represents the information seen bythe patient. The user interface 600 may, in one example, indicate whichuser interface elements (e.g., 504, 506 a, 506 b in FIG. 5) the patientis activating by lighting up or highlighting the corresponding elements(e.g., 504′, 506 a′, 506 b′) in the user interface 600, or displaying amessage (e.g., in textual command interface 608) that a particularelement is being activated. If the user is attempting to activate a userinterface element, the remote system may indicate whether or not theuser interface element is operating correctly (e.g., patient says he ispressing a button but the button does not show activation on the remotesystem). In this manner, the remote technician may troubleshoot thedevice by asking the patient to activate certain user interface elementsand monitoring the user interface 600 of the system to see if the deviceresponds accordingly.

In another example, the remote technician may type or draw on the userinterface 600, and the typing or drawing will be sent to the device anddisplayed on the local user interface for the patient to see. Forexample, for demonstration or tutorial purposes, the remote technicianmay use a cursor or touch screen on a remote computer system operativelyconnected to a server. The server may then cause the cursor and relatedinformation (e.g., x-y coordinates of the technician's cursor and/or oneor more codes representing a current graphical interface andcorresponding state within a given state machine) over thecommunications session to the device, which causes the device to draw acursor for guiding the patient through the operation of the device. Inanother example, the remote technician may remotely force the device todisplay certain screens on the local user interface for the patient toview. For example, if the technician is guiding a patient through thesteps of how to respond to a therapeutic shock, the technician can causecertain screens to be displayed that the patient will ordinarily see innormal operation. In some examples, the functionality variouslydescribed in this paragraph may be protected by security so as torequire permission from the patient before the remote technician isallowed to view or otherwise control the device remotely. As the remotetechnician interacts with the user interface 600, in some examples, theremote system can send a command to effect a same or substantially samechange to the corresponding device screen.

In some implementations, a technician may cause one or more trainingmodules to be deployed to the medical device for training and/ordemonstrating one or more features of the medical device. For example,the modules may be deployed as preconfigured executable scripts that aredelivered to the medical device over a remote communication session. Thescripts can be executed by the device to present a guided tutorial orother information to the patient via the user interface. In certainimplementations, some modules may be preloaded on the medical device,and remotely activated via the communication session. For example, oneor more of the following training modules may be provided in thismanner: a treatment/siren alarm module, an after-treatment module, aresponse button module, a gong alert module, electrode falloff module,garment care and maintenance module, battery charge and maintenancemodule, among others. Each module can be in the form of one or moremedia types or a mix of media (e.g., slides with images, videos, text,and/or audio content) and vary in levels of technical sophistication.

The technician can activate a technical support mode or other demo modeof the device over the remote communication session. In suchimplementations, medical devices like external ambulatory therapeuticdevices (e.g., defibrillator) can be configured to continue monitoringthe patient for underlying medical conditions that the device can treat(e.g., cardiac arrhythmias). As such, even if a remote communicationsession is ongoing, the device is configured to carry out its criticalfunctionality without interruption.

In implementation, once the remote communication session is activated atwo-way communication path is established. The technician can remotelycontrol the sequence, operation, and timing of the training modules overthe path. For example, the remote server can send instructions in theform of, for example, XML, or JSON code, to control the content andduration of display of the training module media.

FIG. 10 shows several screen shots of an example training module for amedical device, in accordance with an embodiment. As shown, the devicecan be configured to display a sequence of informational and interactivescreens for guiding a patient through the training module. For example,the first screen 1010 may display information about a particular feature(e.g., a gong alert) of the device. The remote server may then cause thesecond screen 1020 to display when the remote technician requests itremotely. The third through sixth example screens 1030, 1040, 1050, 1060each include one or more interactive elements 1070 that the patient mayactivate to perform an operation within the training module, such asadvancing to the next or previous screen, or activating a feature of thedevice (e.g., play a gong sound or start an optional section of thetraining module). Other examples of training modules are described inU.S. Provisional Patent Application Ser. No. 62/235,883, entitled“Training Modules for External Medical Device” and filed on Oct. 1,2015, which is incorporated herein by reference in its entirety.

In some examples, as shown in FIG. 6, the user interface 600 includesadditional elements that can be used to remotely monitor or control thedevice, such as buttons 604, alarm status 606, and a textual commandinterface 608. These additional elements may not necessarily beavailable to the patient via the user interface 408, but enable atechnician to interact with the device 100 in several ways. For example,the buttons 604, when activated by the technician, may initiate orterminate a remote connection with the device 100, cause the device 100to execute a diagnostic test, retrieve and display an operational statusof the device 100 in the user interface 600 (e.g., display an event oralarm history, the amount of time the patient has been wearing thedevice, or other device information in the alarms region 606), activateor deactivate a remote control function, or any combination of these orother relevant functions. In some examples, the user interface includesthe textual command interface 608, which enables the technician to typecommands using a keyboard, and send the commands to the device 100, aswell as to view information received from the device 100, such asresponses to the commands. In some cases, the textual command interface608 enables the technician to interact with the device 100 in real timeor near real time for troubleshooting purposes.

Example Use Case

FIG. 7 shows an example system 700 in accordance with various examples.In the system 700, the system is configured to provide remote access toan ambulatory medical device including the device medical devicecontroller 120 and data communications interface 406 of FIG. 4. Inaddition to the controller 120, the system 700 includes an optional basestation 300 of FIG. 3, a remote system 702, and a data communicationnetwork 704. In some examples, the controller 120 can include anapplication, browser, email client, or some other local componentconfigured to communicate with the remote system 702 via the network704. In some implementations, the controller 120 may communicate withthe network 704 and the remote system 702 via the base station 300 asdescribed herein. The controller 120 is configured to transmit data to,and receive data from, the remote system 702 via the network 704. Suchdata may, for example, include a request to perform a diagnostic test, arequest to establish a communication session with the remote system 702,a request to reconfigure the user interface of the ambulatory medicaldevice, data representing an operational status of the device, and otherdata representing control and monitoring functions of the device, suchas variously described in this disclosure. The remote system 702 caninclude a remote user interface, such as the user interface 600 of FIG.6, and a web browser or other application configured to render at leasta portion of the remote user interface. The network 704 may include anycommunication network through which programmable devices may exchangeinformation. In some examples, the network 704 supports wireless networkand/or wired connections. For instance, the network 704 may support anyof various networking standards such as GSM, CMDA, USB, BLUETOOTH, CAN,ZigBee, Wireless Ethernet, and TCP/IP among others.

The medical device may include any medical device disclosed herein suchas an ambulatory external defibrillator or a cardiac monitor, or anothermedical device that includes the controller 120 of FIG. 4 or similarcomponents. In some examples, the medical device can be associated with,and provides care to, a patient 102. As shown in FIG. 7, the medicaldevice may provide information to a patient 102, a technician 104, orother individual. The technician 104, who is capable of providing thepatient 102 with assistance in the operation and troubleshooting of thedevice, can interact with the controller 120 via the remote system 702.Further, the technician 104 can communicate directly with the patient102 via a telephone or Internet telephony while contemporaneouslyproviding technical assistance via the remote system 702. For example,the technician 104 may ask the patient 102 to describe the behavior ofthe medical device or to press a button on the controller 120 whilespeaking with the patient 102 by telephone.

In some examples, the information presented to the patient 102 via theuser interface of the controller 120 varies depending on a severity of afault or an operational status of the device. In some implementations,the device may be configured to determine the severity of the faultbased on the information below and relay a corresponding service codeand information about one or more actions taken in response to thefault. The device may then determine, based on the severity of thefault, whether to initiate or prompt the patient to initiate the remotecommunication session to allow for a remote technician to service thefault.

In one example, anomalous operational statuses are categorized into twogroups, e.g., Group One and Group Two based on severity. For example,Group One status can be reflected through use of service codes that havea “1” prefix (e.g., service codes “101”, “102”, and so on). When themedical device is in a Group One, or non-critical status, the patientcan continue to use the medical device as prescribed. When the medicaldevice is in a Group Two, or critical status, the patient may need toimmediately seek assistance with (e.g., assistance from a servicetechnician or health care professional) and/or discontinue use of themedical device. For example, Group Two status can be reflected throughuse of service codes that have a “2” prefix (e.g., service codes “201”,“202”, and so on). For example, when the medical device has a Group Twotype critical issue, the patient may be presented with a screenindicating that the device had suffered a serious problem that couldprevent patient treatment operations from occurring. For example, atherapeutic device such as an ambulatory external defibrillator may notbe performing monitoring or treatment operations in such a status.Similarly, a cardiac or other physiological monitoring device may not beperforming patient monitoring in such a status. The device may includeother statuses, groups, or levels of fault severity. In someimplementations, a subset of faults involving, for example, thecommunications module, may trigger different service codes than GroupOne or Group Two service code. For example, communication faults may beassigned to Group Three, and as such the corresponding service codes mayuse a “3” prefix. While numeric service codes and/or use of prefixes aredescribed herein, other types of codes, formats, or symbols may bepossible without deviating from the scope of the disclosure.

When displaying information about a Group One status, which includesless severe, non-critical, anomalous operational statuses, the devicemay provide the patient, via the user interface, with specificinformation about the detected anomaly and its most likely cause(s),along with a message directing the patient to contact a technicalassistance representative while continuing to use the medical device.The technician 104 may, from the remote system 702, then remotelyretrieve information about the status of the device and/or view the userinterface of the device. Example Group One status issues can include oneor more of the following: connection to a base station or other remoteserver is taking too long (e.g., exceeds a predetermined connection timethreshold), such connection may have temporarily failed, another datatransfer or remote communication session may already be in progress,there may be excessive noise on one or more physiological sensors, thebattery may have reached critical charge level and needs to be rechargedor changed, one or more portions of the garment may be improperlyadjusted and needs to be re-adjusted, and one or more components of theelectrode system may have been improperly assembled. In someimplementations, other example non-critical operational status of theambulatory medical device comprises at least one of the following: aconnection to a remote computing device (e.g., remote computing device1204 of FIG. 12 below) exceeds a predetermined connection timethreshold, the connection to the remote computing device may be deemedto have temporarily failed, or another data transfer or remotecommunication session may already be in progress.

When a device fault occurs, the device is configured to determine thatthe type of fault is a Group One fault (non-critical fault). Forexample, if a pulse truncation fault, charge profile fault, or a gelfire fault is detected, the device can trigger a corresponding servicecode. For example, as noted in the table below, the pulse truncationfault may be assigned service code 101. When such a fault is detected,the device may take no immediate action. However, on the next devicepower up, the device may display a screen informing the patient that themonitor needs to be serviced. Following the notification, the device maybe configured to resume normal operation. Similarly, when a chargeprofile fault is detected, the device may be configured to take noimmediate action as long as there is sufficient energy to deliver apulse to the patient, if needed. The device may further provideinstructions to the patient indicating that the operational status orfault is a non-critical operational status or fault, and/or the patientmay continue use of the device contact a remote technician. As such, thedevice may be configured on next power up to display a screen informingthe patient that the monitor needs to be serviced. An example of such a“Call for service” screen 1104 is shown in FIG. 11. As before, followingthe notification, the device may be configured to resume normaloperation.

In an implementation, after the patient calls the remote technician forservice, the device can be remotely entered into a technical supportmode as discussed above. The remote technician can then remotely addressthe issue that led to the service code being declared. In some examples,the remote technician can use the technician support mode to guide thepatient (and/or a support person) through one or more steps relating tothe medical device, e.g., steps to help restore the operational statusof the medical device. For example, the remote technician can use theuser interface to show the patient how to adjust one or more sensors,re-adjust the garment, or detach and re-attach the device battery.

Example Group One status service codes are shown in Table 1 below, alongwith proposed actions to be taken for each of the service codes. Thetable also shows a general description of the corresponding service code(e.g., a description of the fault), an action taken or to be taken bythe device, an action taken or to be taken by the device the next timethe device is powered-up, and a disposition (e.g., an action taken bythe remote technician).

TABLE 1 Group One Status List Disposition (e.g., action by ServiceGeneral Action on next remote code description System action power-uptechnician) 101 Pulse truncation None Service code Controller or fault101 followed by Monitor service normal required operation 102 Chargeprofile None if pulse energy Service code Controller or fault isavailable 102 followed by Monitor service Display “Call for normalrequired help” is no pulse operation energy available 103 Gel fire faultNone Service code Electrode 103 if attached assembly electrode servicerequired assembly indicates gel fire fault 104 A non-critical NoneService Code Controller or memory fault 104 followed by Monitor Service(e.g., an SD Card normal Required Fault) operation 105 Pulse Test RelayService Code 105 If problem Controller or Stuck followed by normalcontinues - Monitor Service operation Service Code Required 105 followedby normal operation 106 Multiple Battery Service Code 106 If problemBattery Service Capacity Test followed by normal continues - RequiredFailures operation Service Code 106 followed by normal operation 107Multiple Service Code 107 Service Code Controller or Abnormal followedby normal 107 followed by Monitor and Shutdowns operation if possiblenormal electrode operation assembly service required 108 Non-CriticalNone Service Code Controller or Database Error 108 followed by MonitorService normal Required operation 109 File System None Service CodeController or Unlocked 109 followed by Monitor Service normal Requiredoperation 110 Over Voltage See code link for Service Code Controller orCleared No more detail 110 followed by Monitor Service Energy normalRequired operation 111 Old Data Files on See code link for Service CodeController or SD Card more detail 111 followed by Monitor Service normalRequired operation 112 Corrupt Disables Service Code Controller orQuestionnaires Questionnaire/Heart 112 followed by Monitor ServiceDatabase Walk and their setup normal Required operation 113 ParametersRecent changes to Service Code New Patient Database Restored ParametersDatabase 114 followed by Setup Required from Backup not saved normal toClear operation

For example, the technician 104 may ask the patient 102 to makeadjustments to the device 100 while monitoring the user interface viathe remote system 702. Additionally or alternatively, the technician 104may remotely access the device and attempt to resolve the problem onbehalf of the patient 102 by sending one or more commands to the devicefrom the remote system 702. For example, the technician may remotelyreset the device, adjust a setting of the device, or initiate a remotereboot of a specific functionality or the entire device, or perform asoftware update or reinstall of a specific functionality or the entiredevice. For example, Group One statuses may be reset by the patientmanipulating the medical device in some predetermined manner (e.g.,pressing an acknowledgment button to acknowledge the event, rebootingthe medical device by pressing a reset button, turning a power switch onand off, or removing and reinserting the same battery or a new battery,etc.), according to instructions provided by the technician 104 over thetelephone. As another example, the technician may remotely access thedevice and reconfigure patient-specific parameters, defaults orpreferences. For example, a technician may reconfigure the user responseinterface to provide alternative user response elements where thediagnostic test indicates a fault with the default response elements, orprovide additional user response elements or configurations according topatient preference.

When displaying information about a Group Two status (critical faults),which includes more severe anomalous operational statuses, the devicemay provide the patient, via the user interface, with specificinformation about the detected anomaly and its most likely cause(s),along with a message directing the patient to immediately contact atechnical assistance representative. In such a case, the technician 104may remotely verify the problem by accessing the device, and uponconfirming the problem or if the device is nonresponsive, inform thepatient that the device needs to be replaced immediately. For example,if a remotely triggered diagnostic test of the converter circuitryfails, the technician may immediately be able to see the results of thetest and inform the patient that the device needs to be replacedimmediately. Group Two statuses cannot be reset because, in such cases,the device is deemed to be non-operational due to failure of a specifictest. In addition, in some implementations, the device may provide thepatient, via the user interface, with additional information whenreporting an anomalous operational status belonging to Group Two. Thisadditional information may include directions for the patient to followimmediately, such as to replace a component of the medical device thatis serviceable by the patient or to remove the device from the patientand discontinue use of the device until the device is repaired.

When a device fault occurs, the device is configured to determine thatthe type of fault is a Group Two fault (a critical fault). For example,if a response button is stuck or the patient parameters becomecorrupted, the device can trigger a corresponding service code which mayindicate that the device is unusable. For example, as noted in the tablebelow, the response button stuck fault may be assigned service code 201.When such a fault is detected, in some examples, the device may causeitself to be immediately disabled. On the next device power up, thedevice may display a screen informing the patient that the monitor needsto be serviced. An example of such a “Call for service” screen 1108 isshown in FIG. 11. For example, such a screen may also include a warningto the patient to discontinue use of the device and contact a support ora remote technician. As shown, the screen may inform the patient thatthe patient may call technical support for assistance. The device mayremain disabled and continue to display screen 1108 until the device hasbeen returned for service.

Example Group Two status service codes are shown in Table 2 below, alongwith proposed actions to be taken for each of the service codes. Thetable also shows a general description of the corresponding service code(e.g., a description of the fault), an action taken or to be taken bythe device, an action taken or to be taken by the device the next timethe device is powered-up, and a disposition.

TABLE 2 Group Two Status List Disposition (e.g., action taken by GeneralAction on next the remote Service code description System actionpower-up technician) 201 One or more System Disabled Service CodeController or response buttons 201 if problem Monitor Service stuck, orresponse continues, required if button signal normal operation problemerror if problem continues resolved 202 Patient System Disabled SystemDisabled - Controller or Parameters Service Code Monitor Service Corrupt202 Required 203 Pulse Test Fault System Disabled System Disabled -Controller or (e.g., the device is Service Code Monitor Service unableto charge 203 Required and deliver a pulse to an internal test load) 204Electrode System Disabled System Disabled - Electrode assembly/ Service204 if assembly and Controller or electrode Controller or Monitorassembly not Monitor Service inoperative replaced, Service Required 204if Controller or Monitor problem, normal operation if electrode assemblyreplaced and Monitor not the problem 205 Audio-visual System DisabledSystem Disabled - Controller or Messaging Data Service Code MonitorService Corrupt 205 Required 206 Shell Application System DisabledSystem Disabled Controller or MD5 Failed Service Code Monitor Service206 Required 207 Patient System Disabled System Disabled - Controller orparameters Service Code Monitor Service Update Fault 207 RequiredInvalid Operating System Disabled System Disabled - Controller or ModeService Code Monitor Service 208 RequiredExample Methodologies

FIG. 8 shows an example device diagnostic test process flow 800 that canbe used in conjunction with an ambulatory medical device, in accordancewith an example of the present disclosure. Initially, the deviceindicates 802 an anomaly to a patient who is using the device. Theindication may result, for example, from one of the diagnostic testsdiscussed with respect to FIGS. 4-7. The indication can includeinformation about the anomaly and a direction for the patient to call atechnician for assistance. The patient then contacts 804 the technicianvia telephone. The technician may ask the patient questions to gatherinformation for troubleshooting and resolving the anomaly. Thetechnician then remotely retrieves the status of the device 806 or otherdiagnostic information, and/or views the user interface of the deviceremotely. Retrieving the status may include, for example, sendingdiagnostic test commands to the device and viewing the results, viewingthe event or alarm history stored in the device, viewing the operatingparameters of the device, or any combination of these or other suitableactions. For example, if the patient has encountered a “Call forservice” screen (e.g., screens 1104 and 1108) with a correspondingservice code, the device status information may include the servicecodes (see, e.g., Tables 1 and 2 above). The remote technician may alsobe able to interrogate the device to retrieve information about anyactions taken by the patient and/or the device in response to theservice codes.

In some cases, after remotely retrieving the status of the device 806,the technician can provide instructions 808 to the patient viatelephone. For example, the technician may direct the patient to press abutton to reset the device, adjust a sensor, replace a battery, ordiscontinue use of the device, depending on the nature of the anomalyand the appropriate actions for resolving the anomaly. Then the patientcan adjust, control, repair or discontinue use 810 of the device per theinstructions. If the actions of the patient resolve the anomaly, thenthe method 800 ends. Otherwise, the technician can continue to remotelyretrieve the status of the device 806 or view the user interface.

In some cases, after remotely retrieving the status of the device 806,the technician can send one or more commands 812 to the device. Forexample, the technician may send a command to reset the device, toperform a diagnostic test on the device, or to control the deviceremotely without intervention by the patient. If the actions of thetechnician resolve the anomaly, then the method 800 ends. Otherwise, thetechnician can continue to remotely retrieve the status of the device806 or view the user interface.

FIG. 9 shows a flow diagram of an example methodology 900 performed byan exemplary system for remotely controlling or determining the statusof an ambulatory medical device, in accordance with various examples ofthe present disclosure. For example, methodology 900 can be implementedand/or performed by the medical device and/or system (e.g., controller120 and associated components forming the medical device and/or system).For instance, in one example, the methodology 900 can be performed bythe remote access manager 428 of FIG. 4, in conjunction with any otherelement of the medical device controller 120. The methodology 900includes monitoring 902 for a request 904 from a remote system. In someexamples, the ambulatory medical device includes, or is configured to becoupled to, a base station configured to communicate with thecontroller. In some examples, the request from the remote systemincludes a text message received over at a fixed line telecommunicationsnetwork or a mobile telecommunications network. In either such examples,the request from the remote system can be routed to the controller viathe base station or a mobile device.

When executing the act of monitoring 902 in some examples, the remoteaccess manager 428 is configured to operate in a low power mode or anormal power mode. In some such cases, the remote access manager 428 isconfigured to periodically monitor for a diagnostic test command lessfrequently while operating in the low power mode than while operating inthe normal power mode to conserve power. For example, the base stationmay receive and buffer a diagnostic test command or other command fromthe remote system until the remote access manager polls the base stationfor such command. In a normal power mode, every few minutes (e.g., every1 minute, 5 minutes, 10 minutes, 15 minutes, etc.), the remote accessmanager 428 can cause the medical device to poll the base station via awireless connection for a buffered request or command. In a low powermode, the frequency may be increased to 30 minutes, 1 hour, or more. Inan implementation, instead of or in addition to polling a local basestation, the medical device may poll a remote computer system or serverapplication for such buffered commands.

In some implementations, the medical device may itself be configured tobe in a low power mode (e.g., certain functionality of the device may beinactive, such as, user interface, data communications, etc.). Forexample, in certain implementations, the ambulatory medical device isconfigured to consume less power while operating in the low power modethan while operating in the normal power mode. For instance, whileoperating in the low power mode, certain functions of the device thatare not needed at all times (e.g., the user interface, and the datacommunications interfaces) may be temporarily disabled or maytemporarily operate less frequently than in the normal power mode so asto conserve battery power. In such implementations, the remote accessmanager 428 can be configured check for a buffered command at apredetermined frequency (e.g., every 1 minute, 5 minutes, 10 minutes,etc.) and then cause the medical device to reenter the low power modeuntil the next polling interval has elapsed if no buffered request orcommand is available. If such a request or command is available, theremote access manager may retrieve the request or command and performthe corresponding diagnostic test or other action, accordingly.

In some examples, the request from the remote system is a request toperform a diagnostic test, which causes the controller to perform thediagnostic operation 906 in response to the request. Examples of thediagnostic test include requesting the last time a converter orcapacitor has been charged or tested, or performing an audio test. Insome cases, the remote access manager is further configured to transmitdata representing an operational status of the ambulatory medical deviceto the remote system. In some cases, the operational status of thecontroller results from performing the diagnostic test (e.g., theoperational status may include the results of the diagnostic test, suchas pass or fail, or the values of certain parameters that indicatewhether the device is operating normally or abnormally). However, theoperational status of the controller can include other information notresulting from the diagnostic test, such as device identity, run time,patient wear time, event history, alarm history, or other informationthat is generated by the controller. In some cases, the remote accessmanager is further configured to send the data representing theoperational status of the ambulatory medical device in real time orsubstantially in real time, although it will be understood that the datacan be sent at any time. For example, the diagnostic test may beperformed in real time (e.g., as soon as the request is issued by theremote system and received by the device), or delayed (e.g., at somepoint in time after the request is issued by the remote system, such aswhen the request is buffered in the base station before beingtransmitted to the device). In some cases, the remote access manager isfurther configured to detect an anomalous condition of the controller,and to transmit data representing an operational status of theambulatory medical device to the remote system in response to detectingthe anomalous condition.

In some examples, the data representing the operational status of theambulatory medical device includes a web page configured to present avirtual user interface to the ambulatory medical device via a webbrowser, such as shown and described above with respect to FIG. 6. Forexample, the data may be used to generate, in the web browser, a virtualcopy or other representation of the user interface of the device toenable a technician to remotely view and interact with the device. Thevirtual copy or other representation of the user interface, as viewed bythe technician, may be visually similar to the local user interface asseen by the patient, however it will be understood that the userinterface presented to the technician may include more or lessinformation than presented to the patient, and that the information maybe displayed by the web browser in a different format or arrangement onthe screen than in the local user interface.

Referring again to FIG. 9, in one example, the request from the remotesystem is a request 908 to communicate with a remote system, whichestablishes a communication session 910 with the remote system inresponse to the request. In some cases, the remote access manager isfurther configured to transmit data representing an operational statusof the ambulatory medical device 912 to the remote system via thecommunication session. In some such cases, the data representing theoperational status of the ambulatory medical device is transmitted inresponse to the request. In some such cases, the remote access manageris further configured to detect an anomalous condition 914 of thecontroller, and to transmit the data representing the operational statusof the ambulatory medical device 912 to the remote system via thecommunication session in response to detecting the anomalous condition.In some cases, the remote access manager is further configured totransmit the data representing the operational status of the ambulatorymedical device in real time or substantially in real time, although itwill be understood that the data can be sent at any time. In some cases,the data representing the operational status of the ambulatory medicaldevice includes a web page configured to present a virtual userinterface to the ambulatory medical device via a web browser, such asdescribed above with respect to FIG. 6.

Referring again to FIG. 9, in one example, the user interface includesat least two user input elements (e.g., the elements 506 a and 506 b ofFIG. 5). One of the user elements is configured to control anoperational function of the ambulatory medical device, and another oneof the user input elements is configured to control another operationalfunction of the ambulatory medical device. In some cases, request fromthe remote system is a command to reconfigure the user interface 916. Insuch cases, the controller is further configured to reconfigure the userinterface 918 to cause one of the user input elements to control anotheroperational function instead of the original operational function ofthat user input element. In some such cases, one of the user inputelements is in an anomalous or inoperative condition.

As mentioned above, in some examples, the user interface 408 includes atleast two user input elements (e.g., physical switches 506 a and 506 b,virtual button 504, or any combination of these). The user inputelements may be configured to control the same operational function ofthe ambulatory medical device 100. For example, both of the user inputelements (e.g., buttons 506 a and 506 b) may be configured as a responsebuttons that when depressed indicates to the controller 120 that thepatient is conscious, which causes the controller 120 to withhold thedelivery of therapeutic defibrillating shocks in the event of a detectedcardiac event. As noted above, a failure of the user input element(e.g., button 506 a) may pose a serious risk to the patient. To thisend, in some examples, the controller 120 is further configured toreconfigure the user interface 408 to cause one of the user inputelements (e.g., 506 b) to control the same operational function asanother one of the user input elements (e.g., 506 a). Such areconfiguration may be desirable, for example, when one of the userinput elements (e.g., user input element 506 a) is experiencing amalfunction or is otherwise inoperative, so that another user inputelement (e.g., user input element 506 b) can be used at leasttemporarily to supplant the inoperative user input element (e.g., userinput element 506 a). In another example, if one of the user inputelements 506 a is configured to cause Function A to be performed whenthe user input element 506 a is activated by the patient, and anotherone of the user input elements 506 b is configured to cause Function Bto be performed when the user input element 506 b is activated by thepatient, then the controller 120 may reconfigure the user input element506 b to perform Function A instead of Function B, or vice versa. Suchreconfiguration of the user interface 408 can remain in placeindefinitely, or at least until the inoperative portion of the userinterface 408 is repaired.

The processes disclosed herein each depict one particular sequence ofacts in a particular example. The acts included in these processes maybe performed by, or using, one or more computer systems speciallyconfigured as discussed herein. Some acts are optional and, as such, maybe omitted in accord with one or more examples. Additionally, the orderof acts can be altered, or other acts can be added, without departingfrom the scope of the systems and methods discussed herein. Furthermore,as discussed above, in at least one example, the acts are performed on aparticular, specially configured machine, namely a medical deviceconfigured according to the examples disclosed herein.

Mobile-Based Communication Systems

As described above, in an implementation, the controller 120 is in datacommunication with one or more remote computing devices (e.g., mobileremote computing device 317 of FIG. 3). In some examples, a remotetechnician may access the controller 120 over a remote communicationsession established between the medical device controller 120 and themobile remote computing device 317.

FIG. 12 illustrates a remote diagnostic system 1200 in accord with someof these examples. As shown, the remote diagnostic system 1200 includesa medical device 1202, a remote computing device 1204, a remote server1212 (e.g., accessible to a remote technician via a workstation), anetwork connection 1206 and a communication network 1214. The medicaldevice 1202 exchanges information with the remote computing device 1204via the network connection 1206. Similarly, the remote computing device1204 may exchange information with the remote server 1212 via thenetwork 1214. In at least one example, the remote server 1212 can beconfigured to deploy or download one or more components (e.g., programsor “apps”) to the remote computing device 1204 that cause the remotecomputing device 1204 to transmit particular commands to the medicaldevice 1202. In some implementations, the remote server 1212 can beconfigured to deploy or download the one or more components to themedical device 1202 (e.g., containing the controller 120).

The medical device 1202 may include a controller 120 implementing aremote access manager 428 as shown in FIG. 4. For example, the remoteaccess manager 428 may be implemented as a limited functionalitycomponent for facilitating the interactions shown in FIG. 12. In someimplementations, the remote computing device 1204 may be releasablysecured and/or coupled into a receptacle of the base station.

In an implementation, a plug-in or application can be deployed ordownloaded on the medical device 1202 and/or the remote computing device1204 to process data, returning only the results, in order to save datausage. As such, a remote technician may cause the plug-in to be deployedor downloaded over a remote communication session and receive theresults of the data in real time or substantially real time. Forexample, a software module (e.g., an extensible application programminginterface or API) can be provided on the controller 120 that iscontrolled by the remote computing device 1204 in a secure and limitedway. The limited functionality module can be configured to be limited inits functionality such that it operates within the environment of thecontroller 120 but is unable to affect the controller's 120 criticalfunctionality. For example, in an implementation where the remotecomputing device 1204 is a non-medical device such as a smartphone, anapp may be provided on the smartphone to control the limitedfunctionality software module of the controller 120. The app mayseamlessly receive instructions from the remote server 1212 and causeone or more of the instructions to be executed on the medical device1202. The remote technician may then access the app and cause the app toexecute instructions on the limited functionality software module of thecontroller 120.

For example, the module may not be permitted to alter or effect changesto any of critical device functions, such as treatment parameters,critical device self-tests, and power management. The module may,however, be permitted to write certain messages to the controller 120'suser interface, for example, at predetermined times, or enable one ormore alerts mechanisms. For example, it may be desirable to remind apatient to take his/her medication at a prescribed time. Theinstructions may be sent to the limited functionality module by theremote controller when the device is within range of the controller. Themodule's access to the rest of the monitor software can be securelylimited by only enabling certain API-functionality. For example, themodule may receive commands from the remote device relating to providingstatuses of certain device parameters without being able to change anyof the parameters. For example, the module may be able to provide devicestatus(es), electrode(s) status(es), battery information, etc.

For example, the module may be able to issue instructions relating to apatient's rehabilitation (directed rehabilitation) at predeterminedtimes. For example, the module may be able to monitor a patient'scompliance with the instructions and report back information relating tothe patient's compliance.

Additional details regarding the configuration of the remote computingdevice 1204 and/or the medical device 1202 can be found in described inU.S. patent application Ser. No. 15/233,245, entitled “SECURE LIMITEDCOMPONENTS FOR USE WITH MEDICAL DEVICES” and filed on Aug. 10, 2016,which is incorporated herein by reference in its entirety.

In various examples, the remote computing device 1204 is implementedusing any of a variety of programmable devices (e.g., a device with datastorage and at least one processor in data communication with the datastorage). In some examples, the remote computing device 1204 includes aplurality of interfaces, one or more processors, and a data storagedevice coupled to one another via a communication mechanism, such as abus. In these examples, the remote computing device 1204 also includes abattery to power the device and may include one or more antennas. Theplurality of interfaces in the remote computing device 1204 include auser interface, a network interface configured to communicate with thenetwork 1206, and a medical device interface configured to exchangeinformation with the medical device. This information may include one ormore limited functionality commands. Particular examples of the remotecomputing device 1204 include medical devices (e.g., in FIG. 12, medicaldevices other than medical device 1202), wearable devices, smart phones,tablet computers, and laptop computers. Wearable devices that may serveas the remote computing device 1204 include various garments withintegrated technologies, watches, anklets, necklaces, belt buckles, andglasses.

As noted above, in examples where the remote computing device 1204 isimplemented via a smart phone, a dedicated software application (or an“app”) may be downloaded to the smart phone to facilitate theinteractions described herein. In some examples, as an enhanced securitymeasure, the remote computing device 1204 is configured to automaticallyand exclusively execute such an application when the remote computingdevice 1204 is connected to a power source or when the remote computingdevice 1204 powers up. In such examples, the smart phone operates solelyas the remote computing device 1204 for enabling the communications andinteractions described herein. For example, the smart phone may beconfigured to operate in a “kiosk mode” and display only minimalinformation on the user interface during such operation. For instance,the application may be written for an Android, iOS, Windows, or otheroperating system of the smart phone.

In some examples, the remote computing device 1204 is configured to actas an information conduit (or “hotspot”) for the medical device 1202 byexchanging information regarding the medical device 1202, the patient1210, and the environment of the medical device 1202 with a remoteserver 1212 via a communication network 1214. For example, in animplementation where the remote computing device 1204 is configured asan information conduit, the remote computing device 1204 is configuredto pass data between the medical device 1202 and the remote server 1212without modifying the data. In certain cases, the device 1204 mayperform certain limited transformations on the data prior to relayingthe data to the remote server 1212 (or to the medical device 1002 if thedata is being transmitted from the remote server 1212).

In some examples, the remote computing device 1204 can establish anauthenticated and secure connection over the network 1214 via anothercomputing device (e.g., a desktop workstation, laptop workstation,tablet or other such device). For example, the user may cause the remotecomputing device 1204 (e.g., a smart phone) to establish a wired (e.g.,USB connection) or wireless connection (e.g., BLUETOOTH connection) withthe other computing device to connect to the remote server 1212.

According to some examples, the remote computing device 1204 can beconfigured to automatically setup communications between the medicaldevice 1202 and the remote server 1212. In these examples, the remotecomputing device 1204 is further configured to display informationregarding its operation and data communications via a user interface ofthe remote computing device 1004 but restrict user interaction with theuser interface. In some implementations, the user may only be able topower on or off the device. In other implementations, the user may onlybe able to control screen brightness and timeouts. The operation anddata communication information displayed may include battery level,connection strength to the network 1214, status of connectivity betweenthe remote computing device 1204 and the medical device 1202 including,in some cases, status information for any ongoing communications, andversion information for the hotspot component. The remote computingdevice 1204 may transmit the operation and data communicationinformation to the remote server 1212. Additionally, the remotecomputing device 1204 may transmit information descriptive of itslocation to the remote server 1212 (e.g., GPS coordinates or otherposition/location details). In some examples, the remote computingdevice 1004 is configured to transmit information descriptive of theconnection strength to the medical device 1202. Further, in someexamples, the remote computing device 1204 is configured to establish afirewall that will inhibit any unauthorized connections to the medicaldevice 1202. The firewall can be configured to inhibit any connectionsto the medical device 1202 other than through the remote computingdevice 1204. In some examples, the remote computing device 1204 isconfigured to log errors in the data storage of the remote computingdevice 1204 (or a storage in some other location on the network).

In some examples, the remote computing device 1204 is configured toautomatically execute as a hotspot component when the remote computingdevice 1204 is connected to a power source or when the remote computingdevice 1204 powers up. Also, in these embodiments, the remote computingdevice 1204 is configured to exclusively execute the hotspot component.In various implementations, the remote computing device 1204, whenconfigured as the hotspot component or otherwise, complies with 21 CFR §880.6310 which defines a Medical Device Data System (MDDS). In oneexample, the remote computing device 1204 comprises hardware or softwareproducts that can be configured to transfer, store, convert formats, anddisplay medical device data. In such examples, the remote computingdevice 1204 can be configured, using the techniques and systemsdescribed herein, to not modify the data, modify the display of thedata, and/or control the functions or parameters of the medical deviceor any other medical device.

Referring now to FIG. 13, the controller 120 of a medical device 1202can be configured to execute an interface process 1300. For instance, inone example, the interface process 1300 can be performed by the remoteaccess manager 428 of FIG. 4, in conjunction with any other element ofthe medical device controller 120. A corresponding process 1302 isconfigured to be executed on a remote computing device 1204, e.g., asmartphone, tablet, or other personal device of the patient. Forexample, the interface process 300 is configured to periodically monitor(act 1303) for a request and/or a command issued from the remotecomputing device as discussed in detail above. Such a request may be forinformation regarding, e.g., an operational status of the device,results of diagnostic tests, configuration information, and/or patientinformation. In some cases, the request and/or command may be for theremote computing device to assert control over one or more componentsand/or aspects of the medical device 1202 as described herein. Whenexecuting the act of monitoring 1303, in some examples, the remoteaccess manager 428 is configured to operate in a low power mode or anormal power mode as described in connection with FIG. 9 above. Forexample, the remote computing device 1204 may receive and buffer arequest and/or a command from a remote system (e.g., under operation bya technician) until the remote access manager 428 polls the remotecomputing device 1204 for such a request and/or command. For example,such polling may occur every few minutes (e.g., every 1 minute, 5minutes, 10 minutes, 15 minutes, etc.) for a buffered request orcommand. In a low power mode, the frequency may be increased to 30minutes, 1 hour, or more. In an implementation, instead of or inaddition to polling the remote computing device 1204, the medical devicemay poll a remote computer system or server application for suchbuffered commands.

In some implementations, instead of the remote access manager 428monitoring for a request/command, the remote computing device 1204 mayinitiate a communication session by sending a message to the remoteaccess manager 428. Accordingly, a push-based messaging service may beimplemented in which when the remote computing device 1204 has a commandand/or a request to send to the medical device, it can initiate thecommunication session and send the command and/or request.

In act 1310, the remote computing device 1204 transmits a request or acommand to the remote access manager 428. For example, the remotecomputing device 1204 may interrogate or request from the medical deviceinformation concerning the device operational status, service status,device configuration, and/or patient information as described in furtherdetail below. For example, the request or command may be any request orcommand from a predefined command set executable by the remote accessmanager 428. For example, Table 3 below lists some example commands insuch a predefined command set according to at least one implementation.Additional commands also with associated descriptions may be found inU.S. patent application Ser. No. 15/233,245.

TABLE 3 Command Description Request Causes the remote access manager 428to initiate a query to one or (Operational_status); more data sourcesfor Operational_status of the medical device Request and/or associatedcomponents, systems, and subsystems. Data (Service_code); returned mayinclude an operational status or fault criticality level (e.g., a GroupOne or a Group Two), corresponding service code(s), and correspondingactions taken on the medical device in response to the indicatedoperational status. Request Causes the remote access manager 428 toinitiate a query to one or (Device_configuration) more data sources fordevice configuration information Request Causes the remote accessmanager 428 to initiate a query to one or (Patient_info) more datasources for patient information Change Causes the remote access manager428 to change one or more data (Patient_info) records relating topatient information Get (Element_ID) Returns a value of the data elementidentified by Element_ID. Set_Threshold (Value, Creates an associationbetween the specified Value and Element_ID. Element_ID) Watch(Element_ID, Causes the remote access manager 428 to monitor the dataelement Watch_Type, identified by the Element_ID according to theWatch_Type. Report_Frequency) Detected transgressions of the value ofthe data element will be reported to the address specified by theWatcher_Address at a frequency specified by the Report_Frequency.Display_Message Causes the remote access manager 428 to request that theuser (Message_ID) interface of the medical device display a predefinedmessage identified by the Message_ID. Filter_Data Causes the remoteaccess manager 428 to apply a filter (e.g., Low (Data, Filter_ID) Pass,High Pass, Band Pass, Wavelet . . . ) identified by the Filter_ID to theData before transmitting the data to the remote computing device

In act 1304, the remote access manager 428 receives the request orcommand from the remote computing device 1204. In act 1306, the remoteaccess manager 428 processes the command. For example, if the command isa request for a status of a subsystem of the device, or results of adiagnostic test performed by the device, the remote access manager 428can query appropriate data sources within the device and return thecorresponding data and/or results.

In act 1308, the remote access manager 428 transmits to the remotecomputing device 1204 one or more responses resulting from execution ofthe request and/or the command and the interface process 1300 ends. Asdescribed above, depending on the command executed, the response mayinclude information generated by or stored on the medical device. Insome examples, the response includes configuration information thatenables the remote computing device to receive one or more on-goingtransmissions of information from the remote access manager 428. Theseon-going transmissions may be in response to a predetermined condition,substantially in real time, during an occurrence of the predeterminedcondition, in response to user input, in response to a predeterminedtriggering event, continuous over a period of time, substantiallycontinuous over a period of time, during periodic time intervals, orduring aperiodic time intervals.

In act 1312, the remote computing device 1204 can be configured toreceive the one or more responses to the request and/or command. In theact 1314, the remote computing device 1204 processes the response andthe interface process 1302 ends. In some examples, the request from theremote system is a request to perform a diagnostic test, which causesthe remote access manager 428 to perform a diagnostic operation inresponse to the request. Examples of the diagnostic test includerequesting the last time a converter or capacitor has been charged ortested, or performing an audio test. In some cases, the remote accessmanager 428 is further configured to transmit data representing anoperational status of the ambulatory medical device to the remotesystem. In some cases, the operational status of the controller resultsfrom performing the diagnostic test (e.g., the operational status mayinclude the results of the diagnostic test, such as pass or fail, or thevalues of certain parameters that indicate whether the device isoperating normally or abnormally). However, the operational status ofthe controller can include other information not resulting from thediagnostic test, such as device identity, run time, patient wear time,event history, alarm history, or other information that is generated bythe controller. In some cases, the remote access manager is furtherconfigured to send the data representing the operational status of theambulatory medical device in real time or substantially in real time,although it will be understood that the data can be sent at any time.For example, the diagnostic test may be performed in real time (e.g., assoon as the request is issued by the remote system and received by thedevice), or delayed (e.g., at some point in time after the request isissued by the remote system, such as when the request is buffered in thebase station before being transmitted to the device). In some cases, theremote access manager is further configured to detect an anomalouscondition of the controller, and to transmit data representing anoperational status of the ambulatory medical device to the remote systemin response to detecting the anomalous condition.

In some examples, the data representing the operational status of theambulatory medical device includes a web page configured to present avirtual user interface to the ambulatory medical device via a webbrowser, such as shown and described above with respect to FIG. 6. Forexample, the data may be used to generate, in the web browser, a virtualcopy or other representation of the user interface of the device toenable a patient to view and interact with the device via the remotecomputing device 1204 instead of the user interface of the medicaldevice.

The request from the remote system via the remote computing device 1204can be a request to communicate with a remote system, which establishesa communication session with the remote system via the remote computingdevice 1204 in response to the request. Accordingly, in someimplementations, the remote access manager 428 is configured to transmitdata representing an operational status of the ambulatory medical device912 to the remote system via the remote computing device 1204. In somesuch cases, the remote access manager 428 is configured to detect ananomalous condition of the controller, and to transmit the datarepresenting the operational status of the ambulatory medical device tothe remote system via the remote computing device 1204 in response todetecting the anomalous condition. In some cases, the remote accessmanager is further configured to transmit the data representing theoperational status of the ambulatory medical device in real time orsubstantially in real time, although it will be understood that the datacan be sent at any time.

In some cases, a request from the remote system is a command toreconfigure the user interface in the event a user interface element isrendered inoperative. In such cases, the controller is furtherconfigured to reconfigure the user interface via the remote computingdevice 1204 to cause one of the user input elements to control anotheroperational function instead of the original operational function ofthat user input element as described in detail below (e.g., seedescription of user interface 408).

The processes disclosed herein each depict one particular sequence ofacts in a particular example. The acts included in these processes maybe performed by, or using, one or more computer systems speciallyconfigured as discussed herein. Some acts are optional and, as such, maybe omitted in accord with one or more examples. Additionally, the orderof acts can be altered, or other acts can be added, without departingfrom the scope of the systems and methods discussed herein. Furthermore,as discussed above, in at least one example, the acts are performed on aparticular, specially configured machine, namely a medical deviceconfigured according to the examples disclosed herein.

Having thus described several aspects of at least one example, it is tobe appreciated that various alterations, modifications, and improvementswill readily occur to those skilled in the art. For instance, examplesdisclosed herein may also be used in other contexts. Such alterations,modifications, and improvements are intended to be part of thisdisclosure, and are intended to be within the scope of the examplesdiscussed herein. Accordingly, the foregoing description and drawingsare by way of example only.

What is claimed is:
 1. An external ambulatory medical device comprising:an electrode subsystem including an electrocardiogram (ECG) sensorconfigured to monitor an ECG signal of a patient over an extended periodof time; a controller operatively coupled to the ECG sensor andconfigured to monitor the ECG signal over the extended period of time; aremote access manager operatively coupled to the controller andconfigured to monitor for a command from a remote system or from aremote computing device to perform a diagnostic test, and to cause thecontroller to perform the diagnostic test in response to the command,the diagnostic test comprising identifying whether an operational statusof the external ambulatory medical device is in a critical operationalstatus or in a non-critical operational status; a user interfaceoperatively coupled to the controller and configured to display aninstruction to the patient indicative of the operational status of theexternal ambulatory medical device, the instruction comprising at leastone of discontinuing use of the external ambulatory medical device andcontacting a remote technician where the operational status is thecritical operational status, and continuing use of the externalambulatory medical device and contacting a remote technician where theoperational status is the non-critical operational status; and a datacommunications interface configured to transmit data representing theoperational status to the remote system or the remote computing device.2. The external ambulatory medical device of claim 1, wherein theelectrode subsystem further includes at least one of a gel deploymentsubsystem, a sensing electrode subsystem, a therapy electrode subsystem,and a signal acquisition and processing subsystem.
 3. The externalambulatory medical device of claim 2, wherein the gel deploymentsubsystem is configured to dispense impedance reducing gel on a body ofthe patient.
 4. The external ambulatory medical device of claim 1,wherein the critical operational status of the external ambulatorymedical device comprises at least one of: an operational status wherethe external ambulatory medical device is nonresponsive; an operationalstatus where the electrode subsystem is malfunctioning or requirescalibration; an operational status where at least one of one or moreresponse buttons of the external ambulatory medical are stuck and aresponse button signal error has occurred; an operational status whereat least one of one or more patient parameters is deemed corrupted andan update of the one or more patient parameters has failed; anoperational status where the at least one of the electrode subsystem andthe controller is deemed inoperative; an operational status where theexternal ambulatory medical device fails a pulse test; an operationalstatus where the external ambulatory medical device is in an invalidoperating mode; and an operational status where the external ambulatorymedical device is nonresponsive.
 5. The external ambulatory medicaldevice of claim 1, wherein the non-critical operational status of theexternal ambulatory medical device comprises at least one of: aconnection to a base station exceeds a predetermined connection timethreshold; the connection to the base station may be deemed to havetemporarily failed; another data transfer or remote communicationsession may already be in progress; a connection to a remote computingdevice exceeds a predetermined connection time threshold; the connectionto the remote computing device may be deemed to have temporarily failed;another data transfer or remote communication session may already be inprogress; excessive noise on one or more physiological sensors; anoperational status where a battery has reached a critical charge leveland needs to be recharged or changed; an operational status where atleast one of one or more portions of a garment is deemed to be in needof adjustment, and one or more components of the electrode subsystem isdeemed to have been improperly assembled; a pulse truncation fault; acharge profile fault; a gel fire fault; a non-critical memory fault; anda non-critical database fault.
 6. The external ambulatory medical deviceof claim 1, wherein the remote access manager is further configured tosend the data representing the operational status of the externalambulatory medical device in real time or substantially in real time. 7.The external ambulatory medical device of claim 1, wherein the userinterface is configured to present the operational status of theexternal ambulatory medical device as a web page implementing a virtualuser interface.
 8. The external ambulatory medical device of claim 1,further comprising a security manager operatively coupled to thecontroller and configured to limit an ability of the remote system tocontrol the external ambulatory medical device.
 9. The externalambulatory medical device of claim 1, wherein the remote computingdevice is a base station configured to communicate with the controller,wherein the command from the remote system is routed to the controllervia the base station.
 10. The external ambulatory medical device ofclaim 1, wherein the remote computing device includes a mobile deviceconfigured to communicate with the controller, wherein the command fromthe remote system is routed to the controller via the mobile device. 11.The external ambulatory medical device of claim 10, wherein the remotecomputing device is a smartphone, a tablet, a wristwatch, or an armbandconfigured to communicate with the controller.
 12. The externalambulatory medical device of claim 1, wherein the command from theremote system or from the remote computing device to perform thediagnostic test comprises a text message to a user received over atleast one of a fixed line telecommunications network and a mobiletelecommunications network.
 13. The external ambulatory medical deviceof claim 1, wherein the command to perform the diagnostic test isreceived from the remote computing device.
 14. The external ambulatorymedical device of claim 13, wherein the command to perform thediagnostic test is initiated on a periodic basis.
 15. The externalambulatory medical device of claim 1, wherein the external ambulatorymedical device is configured to operate in a low power mode or in anormal power mode, wherein the external ambulatory medical deviceconsumes less power while operating in the low power mode than whileoperating in the normal power mode.
 16. The external ambulatory medicaldevice of claim 15, wherein the remote access manager is furtherconfigured to periodically monitor for the command less frequently whilethe external ambulatory medical device is operating in the low powermode than while the external ambulatory medical device is operating inthe normal power mode.
 17. The external ambulatory medical device ofclaim 1, further comprising a wearable medical device.
 18. The externalambulatory medical device of claim 1, wherein the external ambulatorymedical device is configured to be operatively coupled to a garment wornabout a torso of a patient.
 19. A system comprising: an electrodesubsystem including an electrocardiogram (ECG) sensor configured tomonitor an ECG signal of a patient over an extended period of time; acontroller operatively coupled to the ECG sensor and configured tomonitor the ECG signal over the extended period of time; a remote systemoperatively coupled to the controller via a data communication network;a remote access manager operatively coupled to the controller andconfigured to monitor for a command from the remote system to perform adiagnostic test, and to cause the controller to perform the diagnostictest in response to the command, the diagnostic test comprisingidentifying whether an operational status of the system is in a criticaloperational status or in a non-critical operational status; a userinterface operatively coupled to the controller and configured todisplay an instruction to the patient indicative of the operationalstatus of the system, the instruction comprising at least one ofdiscontinuing use of the system and contacting a remote technician wherethe operational status is the critical operational status, andcontinuing use of the system and contacting a remote technician wherethe operational status is the non-critical operational status; and adata communications interface configured to transmit data representingthe operational status to the remote system.
 20. The system of claim 19,wherein the remote system includes a remote user interface configured todisplay text and graphics generated at least in part by the controller.